Leprosy and identity in the Middle Ages: From England to the Mediterranean 9781526127426

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Leprosy and identity in the Middle Ages

SOCIAL HISTORIES OF MEDICINE

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Series editors: David Cantor, Elaine Leong and Keir Waddington Social Histories of Medicine is concerned with all aspects of health, illness and medicine, from prehistory to the present, in every part of the world. The series covers the circumstances that promote health or illness, the ways in which people experience and explain such conditions, and what, practically, they do about them. Practitioners of all approaches to health and healing come within its scope, as do their ideas, beliefs and practices, and the social, economic and cultural contexts in which they operate. Methodologically, the series welcomes relevant studies in social, economic, cultural and intellectual history, as well as approaches derived from other disciplines in the arts, sciences, social sciences and humanities. The series is a collaboration between Manchester University Press and the Society for the Social History of Medicine. Previously published Migrant architects of the NHS  Julian M. Simpson Mediterranean quarantines, 1750–​1914  Edited by John Chircop and Francisco Javier Martínez Sickness, medical welfare and the English poor, 1750–​1834  Steven King Medical societies and scientific culture in nineteenth-​century Belgium Joris Vandendriessche Vaccinating Britain  Gareth Millward Madness on trial  James E. Moran Early Modern Ireland and the world of medicine  Edited by John Cunningham Feeling the strain  Jill Kirby Rhinoplasty and the nose in early modern British medicine and culture  Emily Cock Communicating the history of medicine  Edited by Solveig Jülich and Sven Widmalm Progress and pathology  Edited by Melissa Dickson, Emilie Taylor-​Brown and Sally Shuttleworth Balancing the self  Edited by Mark Jackson and Martin D. Moore Accounting for health: Calculation, paperwork and medicine, 1500–​2000 Edited by Axel C. Hüntelmann and Oliver Falk Women’s medicine  Caroline Rusterholz Germs and governance: The past, present and future of hospital infection, prevention and control  Edited by Anne Marie Rafferty, Marguerite Dupree and Fay Bound Alberti

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Leprosy and identity in the Middle Ages From England to the Mediterranean Edited by

Elma Brenner and François-​Olivier Touati

Manchester University Press

Copyright © Manchester University Press 2021

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While copyright in the volume as a whole is vested in Manchester University Press, copyright in individual chapters belongs to their respective authors. An electronic version of Chapter 12 is also available under a Creative Commons (CC-​BY-​NC-​ND) licence, thanks to the support of the Wellcome Trust, which permits non-​commercial use, distribution and reproduction provided the editors, chapter authors and Manchester University Press are fully cited and no modifications or adaptations are made. Details of the licence can be viewed at https://​creativecommons.org/​licenses/​by-​nc-​nd/​4.0/​. Published by Manchester University Press Altrincham Street, Manchester M1 7JA www.manchesteruniversitypress.co.uk British Library Cataloguing-​in-​Publication Data A catalogue record for this book is available from the British Library ISBN 978 1 5261 2741 9 hardback First published 2021 The publisher has no responsibility for the persistence or accuracy of URLs for any external or third-​party internet websites referred to in this book, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Cover image: Richard Tennant Cooper, People scrambling to get away from a leper, c. 1910 (Wellcome Collection, CC BY 4.0) Cover design: riverdesignbooks.com

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Contents

List of figures List of tables Notes on contributors Acknowledgements List of abbreviations Introduction – Elma Brenner and François-​Olivier Touati

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Part I:  Approaching leprosy and identity 1 Reflections on the bioarchaeology of leprosy and identity, past and present – Charlotte Roberts 2 Lepers and leprosy: connections between East and West in the Middle Ages – François-​Olivier Touati 3 The disease and the sacred: the leper as a scapegoat in England and Normandy (eleventh–​twelfth centuries) – Damien Jeanne

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Part II:  Within the leprosy hospital: between segregation and integration 4 ‘A mighty force in the ranks of Christ’s army’: intercession and integration in the medieval English leper hospital – Carole Rawcliffe 5 Saint Mary Magdalen, Winchester: the archaeology and history of an English leprosarium and almshouse – Simon Roffey 6 Diet as a marker of identity in the leprosy hospitals of medieval northern France – Elma Brenner

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Contents Part III:  Beyond the leprosy hospital: the language of poverty and charity

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7 Good people, poor sick: the social identities of lepers in the late medieval Rhineland – Lucy Barnhouse 8 The clapper as ‘vox miselli’: new perspectives on iconography – Luke Demaitre

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Part IV:  Religious and social identities 9 Kissing lepers: Saint Francis and the treatment of lepers in the central Middle Ages – Courtney A. Krolikoski 10 From pilgrim to knight, from monk to bishop: the distorted identities of leprosy within the Order of Saint Lazarus – Rafaël Hyacinthe 11 Connotation and denotation: the construction of the leper in Narbonne and Siena before the plague – Anna M. Peterson

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Part V:  Post-​medieval perspectives 12 ‘Our loathsome ancestors’: reinventing medieval leprosy for the modern world, 1850–​1950 – Kathleen Vongsathorn and Magnus Vollset

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Index

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Figures

1.1 Skull of a medieval person with leprosy showing: (A) widening of the nasal aperture (‘nose opening’); (B) loss of the anterior ‘spine’; (C) loss of the front teeth (incisors). Photograph: Charlotte Roberts. 1.2 Damage to the nasal structures of the face in a person with leprosy. Figure 70 in K. Mitsuda, Atlas of Leprosy (Okayama: Nanko-​Do Publishing Co., 1952). 1.3 Twenty-​eight-​year-​old woman with leprosy. Plate in D. C. Danielssen, J. L. Losting and W. Boeck, Om Spedalskhed … Atlas (Bergen: [F. D. Beyer], 1847). London, Wellcome Collection, EPB G. O/​S F.178. CC BY. 1.4 The foot bones of a medieval person with leprosy buried in the Danish leprosarium cemetery at Naestved, together with normal foot bones for comparison. Photograph: Charlotte Roberts. 2.1 The early-​ninth-​century ivory panels of the Andrews Diptych, Victoria and Albert Museum, London (A.47&A-​1926). Image © Victoria and Albert Museum, London. 5.1 View of the excavations of Saint Mary Magdalen, Winchester, looking west towards Winchester. Photograph: Simon Roffey. 5.2 Interior of the medieval chapel of Saint Mary Magdalen, Winchester, looking east, prior to its destruction in the 1780s. Drawn by Jacob Schnebbelie (1760–​92). Image: Simon Roffey, personal collection. 5.3 Excavations of the east end of the chapel of Saint Mary Magdalen, Winchester, looking south. Photograph: Simon Roffey.

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5.4 The cemetery of Saint Mary Magdalen, Winchester, looking north. The north wall of the medieval chapel can be seen in the foreground. Photograph: Simon Roffey. 141 5.5 View of the northern cemetery at the leprosarium of Saint Mary Magdalen, Winchester. Note chalk-​cut anthropomorphic graves with inner ledges and head niches. Photograph: Simon Roffey. 142 5.6 Pilgrim burial with in situ scallop shell from Saint Mary Magdalen, Winchester. Photograph: Simon Roffey. 144 5.7 Excavation of the twelfth-​century masonry hall, probably an infirmary, at the leprosarium of Saint Mary Magdalen, Winchester (looking north-​west). Photograph: Simon Roffey. 145 5.8 West end of the medieval infirmary at Saint Mary Magdalen, Winchester. Photograph: Simon Roffey. 148 8.1 Jesus sends ten cleansed leprosi to the priests, and only one of them returns to say thank you. Manuscript page in the ‘Prayerbook of Hildegard’, c. 1190. Munich, Bayerische Staatsbibliothek, Cod. Lat. 935, fo. 43v. © Bildarchiv Foto Marburg (www.fotomarburg.de).212 8.2 Bishop blessing four clerics with spots on their faces and hands. Historiated initial ‘C’ of the heading ‘Clericus debilitatus per infirmitatem ministrans quid iuris’, in James le Palmer, Omne bonum, London, c. 1375. © The British Library Board. London, BL, 213 MS Royal 6 E VI [Vol. II], fo. 301.  8.3 The Charity of Saint Elisabeth, by Hans Holbein the Elder. Right-​hand panel, Triptych of Saint Sebastian, 1516. Alte Pinakothek, Munich. © Bildarchiv Foto Marburg (www.fotomarburg.de).216 8.4 A ‘leprosus’ (so captioned) at the city gate; then healed by ‘Ihesus Christus’. Quill drawing in Rabanus [Maurus, c. 780–​856], De Institutione Clericorum. Reims, Carolingian, ninth century. University and State Library Düsseldorf, MS B. 113, fo. 5r. CC BY-​NC-​ND. 217 8.5 People Scrambling to Get Away from a Leper. Watercolour c. 1910 by Richard Tennant Cooper (1885–​1957). Commissioned by Sir Henry S. Wellcome. London, Wellcome Collection, ICV no. 17398. CC BY. 219

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List of figures 8.6 Three ​hundred images of leprosi –​ chronological distribution. 8.7 ‘The rich man and the poor man (Dives et pauper)’. Relief, side wall of the south porch, Saint Pierre Abbey, Moissac, France. Wikimedia Commons/Jpbazard Jean-Pierre Bazard, CC BY-SA 3.0. 8.8 Provenances of 150 continental images with clappers. 8.9 Themes of 150 continental images with clappers. 8.10 Dives et pauper. Miniature by an unknown master, Saint-​Omer, 1300–​25. In a manuscript of the Bible historiale, completed by Guyart (or Guiard) des Moulins in 1297. Paris, BnF, MS français 152, fo. 413v. 8.11 Dives et pauper. Miniature by Jean Poyet, Loire School, c. 1500. Psalm 114, Office for the Dead at Vespers. Tilliot Hours. © The British Library Board. London, BL, MS Yates Thompson 5, fo. 70v.  8.12 Dives et pauper. Painting by Conrad von Soest (Dortmund, c. 1370–​c. 1422), oil and gold on wood, c. 1400. Philadelphia, PA, Barnes Foundation, item BF 853. Courtesy of the Barnes Foundation. 8.13 ‘Ten leprosi are cleansed. Lu[ke] 17’. Woodcut, illustration to Doctrina, Vita et Passio Iesu Christi; formerly attributed to Hans Schäufelein, 1516–​17; printed in Frankfurt, 1537. London, British Museum, Prints & Drawings No. E.9.23, recto. © The Trustees of the British Museum. 8.14 Christ and the Ten Lepers. Miniature in Vita Christi, Bruges, c. 1485. New York, Morgan Library, MS M.894, fo. 112r. 8.15 Jhesu christ sana los lebrosos. Christ healing a leprosus. Manuscript drawing, attributed to the atelier of the Catalan Master of Saint Mark, in Matfré Ermengau of Béziers, Breviari d’amor, eastern Spain, last quarter of the fourteenth century (‘1385’). © The British Library Board. London, BL, MS Yates Thompson 31, fo. 225. 8.16 Saint Francis giving alms. Detail, altarpiece by Bonaventura Berlinghieri of Lucca, 1235, Church of San Francesco, Pescia, tempera on wood, Byzantine style. Photograph: Kunsthistorisches Institut in Florenz –​ Max-​Planck-​Institut.

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8.17 Saint Martin kisses a leper. Coloured drawing, western France (Tours), third quarter fourteenth century. Tours, Bibliothèque municipale, MS 1018, fo. 36v. © Bibliothèque municipale de Tours. 8.18 Saint Louis of Toulouse (1274–​97) washes the feet of a leprosus. Jakob Mühlholzer, c. 1494. Left wing of the altarpiece (by Tilman Riemenschneider), Church of Saint Jacob, Rothenburg an der Tauber. Photograph: Luke Demaitre. 8.19 Meseaux burned alive. Marginal drawing in French translation of Bernardus Guidonis, Fleurs des chroniques, Paris, after 1384. IRHT-CNRS, Besançon, Bibliothèque municipale, MS 0677, fo. 77. 8.20 A sister of the Hôpital Notre-​Dame, Tournai, greets a leprous patient. Statutes of the Sisters of the Hôpital Notre-​Dame, Tournai, c. 1400. Tournai, Cathedral Archive, MS 24, fo. 4v. Courtesy of Professor Jacques Pycke and Archives de la Cathédrale de Tournai. 8.21 A leprosus holding a clapper. Detail, back of the Flugelaltar-​Predella known as the Arndorfer Altar, north aisle of the Pfarrkirche, Maria Saal, Carinthia, Austria, 1510–​20. 8.22 H[eilige] Lazerus. Polychrome wood statue, second quarter of the sixteenth century, Lazaruskapel, Rumst, Prov. Antwerp, Belgium. Flamenc/​Wikimedia CC BY-​SA. 8.23 Two dated clappers, issued in Haarlem and now in the Enkhuizen Gemeentehuis Museum, the Netherlands. 10.1 Nineteenth-​century drawing of a seal of the Order of Saint Lazarus, c. 1130–​87. Reproduced from C. S. Clermont Ganneau, ‘Un sceau des croisades appartenant à la léproserie de Saint-​Lazare de Jérusalem’, Recueil d’archéologie orientale, 4 (1901), 242–​6. 10.2 Nineteenth-​century drawing of a seal of the Order of Saint Lazarus dating to 1287 and showing a seated bishop with the legend ‘EPISCOPVS LAZARVS’.

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List of figures Reproduced from A. Nuscheler, ‘Die Lazariterhäuser im Gfenn bei Dübendorf und Schlatt’, Mittheilungen der antiquarischen Gesellschaft in Zürich, 9 (1856), Plate 2. 10.3 Nineteenth-​century drawing of a seal of the Order of Saint Lazarus used in Germany by 1282 and showing a cross. Reproduced from A. Nuscheler, ‘Die Lazariterhäuser im Gfenn bei Dübendorf und Schlatt’, Mittheilungen der antiquarischen Gesellschaft in Zürich, 9 (1856), Plate 2. 10.4 Nineteenth-​century drawing of a seal of the Order of Saint Lazarus dating to 1289 and showing a bishop wearing a cross on his chest. Reproduced from A. Nuscheler, ‘Die Lazariterhäuser im Gfenn bei Dübendorf und Schlatt’, Mittheilungen der antiquarischen Gesellschaft in Zürich, 9 (1856), Plate 2.

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Tables

3.1 Words of purification in Thomas Becket’s miracles relating to leprosy. 3.2 Words denoting the segregation or removal of lepers in Thomas Becket’s miracles.

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Notes on contributors

Lucy Barnhouse, Ph.D., is an Assistant Professor at Arkansas State University, USA. Her research focuses on the intersections between legal, religious and medical history in late medieval Germany. Her prospective monograph, Houses of God, Places for the Sick, examines the place of hospitals in the religious and social networks of late medieval cities. She has made an edition and translation of leprosy examination letters for the Medieval Disability Sourcebook, and has been a podcaster with Footnoting History, on topics including women’s history and medical history, since 2013. Elma Brenner, Ph.D., L.M.S., is a Research Development Specialist at Wellcome Collection, London. She is also an associate member of the Centre de recherches archéologiques et historiques anciennes et médiévales at the University of Caen, France (UMR 6273 – CNRS). Her research explores intersections between health and religious culture in medieval France and England. Among her publications are Memory and Commemoration in Medieval Culture (co-​edited with Meredith Cohen and Mary Franklin-​Brown, 2013), Society and Culture in Medieval Rouen, 911–​1300 (co-​edited with Leonie V. Hicks, 2013) and Leprosy and Charity in Medieval Rouen (2015). Luke Demaitre, Ph.D., was Visiting Professor at the Center for Biomedical Ethics and Humanities at the University of Virginia, Charlottesville, until 2017. He has written on a range of medical notions, norms and practices in Europe before 1600, and his current study focuses on responses to striking diseases. His major publications include Leprosy in Premodern Medicine: A Malady of

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the Whole Body (2007) and Medieval Medicine: The Art of Healing, from Head to Toe (2013). His most recent publication, ‘Official objectives of the Visitatio leprosorum:  Ambiguity, ambivalence, and variance’, appeared in Policing the Urban Environment in Premodern Europe (2019, open access). Rafaël Hyacinthe, Ph.D. (Université Paris I, Panthéon-​Sorbonne), is currently in charge of the hospitaller archives in the Archives départementales de l’Hérault in Montpellier, France. His research is focused on the Order of Saint Lazarus of Jerusalem, from the Middle Ages up to the modern period. Further studies concern charity in medieval southern Italy (Ecole française de Rome), as well as the cult of Saint Lazarus in the East and the West (Centre national de la recherche scientifique). Along with articles and contributions in edited volumes on the history of the crusades, he has published L’Ordre de Saint-​Lazare de Jérusalem au Moyen Age (2003). Damien Jeanne, Ph.D., is a lecturer at the universities of Caen and Le Havre, France. He is an associate member of the Centre de recherches archéologiques et historiques anciennes et médiévales at the University of Caen (UMR 6273 – CNRS). His research addresses the history and place of diseases in western medieval society. He is co-editor of Purifier, soigner ou guérir? Maladies et lieux religieux de la Méditerranée antique à la Normandie médiévale (2020). Other recent publications include ‘Lèpre humiliante, lèpre édifiante:  Hamon de Savigny, novice réputé lépreux au service des lépreux’, in B.  Galbrun and V.  Gazeau (eds), L’Abbaye de Savigny (1112–​2012) (2019); and ‘Bénédiction ou malédiction? Maladies et malades sous le regard des bénédictins (XIe–​ XIIe siècle)’, in P. Bauduin, G. Combalbert, A. Dubois, B. Garnier and C. Maneuvrier (eds), Sur les pas de Lanfranc, du Bec à Caen (2018). Courtney A. Krolikoski is a Ph.D. candidate at McGill University. Her research explores the status of lepers in Bologna, Italy in the high Middle Ages, with attention to the interaction between contemporary social, political, religious and medical understandings of leprosy. She is one of the founders and organisers of the 2018 conference ‘Leprosy and the “Leper” Reconsidered’, and is co-​ editing the resulting volume, Leprosy from the Medieval to the Modern World: A Global Interdisciplinary Approach.

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Notes on contributors

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Anna M. Peterson, Ph.D., is an early-​career researcher who currently focuses on corruption and accountability in medieval hospitals and leprosaria, particularly in the south-​west Mediterranean. She recently completed a Mellon Fellowship at the Pontifical Institute of Mediaeval Studies, Toronto, studying this topic through the lens of Church reforms. She is also one of the founders and organisers of the 2018 conference ‘Leprosy and the “Leper” Reconsidered’, and is co-​editing the resulting volume, Leprosy from the Medieval to the Modern World:  A Global Interdisciplinary Approach. She received her Ph.D. from the University of St Andrews in 2017 for ‘A comparative study of the hospitals and leprosaria in Narbonne, France and Siena, Italy (1080–​1348)’. Carole Rawcliffe, Ph.D., is Professor Emerita of Medieval History at the University of East Anglia, UK. Her many publications focus upon hospitals, public health, responses to disease, and the interconnection between religion and medicine from the eleventh to the sixteenth century. They include Medicine and Society in Later Medieval England (1995), Medicine for the Soul (1999), Leprosy in Medieval England (2006) and Urban Bodies: Communal Health in Late Medieval English Towns and Cities (2013). As well as contributing to numerous academic publications, she has co-​edited a two-​volume history of Norwich (2004), a book of essays on medieval plague (2012) and another on environmental policing in pre-​modern Europe (2019). Charlotte Roberts, Ph.D., S.R.N., Fellow of the British Academy, is an Emeritus Professor of Archaeology at Durham University, UK. She is a bioarchaeologist, with a nursing background. She has studied and interpreted human remains from archaeological sites for the past thirty-​five years. Her key research interests lie in contextual approaches to past human health (palaeopathology); ethics and human remains; contemporary health; evolutionary approaches to the origin and history of infectious diseases, including leprosy; and big-​data projects in palaeopathology. She has published widely throughout her career, including a co-​edited book on leprosy in 2002 (The Past and Present of Leprosy) and many book chapters and journal papers. Most recently she has authored/​co-​authored pieces in the International Journal of Paleopathology (2019), the

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Notes on contributors

International Textbook of Leprosy (2018), and in L.  Tilley and A.  A. Schrenk (eds), New Developments in the Bioarchaeology of Care (2017). She has also authored Human Remains in Archaeology:  A Handbook (2018) and co-​authored Health and Disease in Britain:  From Prehistory to the Present Day (2003), The Bioarchaeology of Tuberculosis (2003) and The Archaeology of Disease (2005). She co-​edited The Backbone of Europe: Health, Diet, Work and Violence over Two Millennia (2018) and A Global History of Paleopathology (2012). Her monograph Leprosy: Past and Present was published in 2020 by the University Press of Florida. Simon Roffey, Ph.D., is a Reader in Medieval Archaeology at the University of Winchester, UK. He was Co-​Director of the recent University of Winchester training excavation of the leprosarium of Saint Mary Magdalen, Winchester. His publications include ‘Medieval leper hospitals in England: An archaeological perspective’, Medieval Archaeology, 56 (2012); ‘Charity and conquest: Leprosaria in early Norman England’, in D.  M. Hadley and C.  Dyer (eds), The Archaeology of the Eleventh Century:  Continuities and Transformations (2017); and (with K.  Tucker), ‘A contextual study of the medieval hospital and cemetery of St Mary Magdalen, Winchester, England’, International Journal of Paleopathology, 2(4) (2012). He also researches more widely on the archaeology of medieval religion and belief, and has published several books on this subject. François-​Olivier Touati, Ph.D., is Professor at the Université François Rabelais, Tours, France. He specialises in the history of medicine and health, and the relationship between the West and the East, in the Middle Ages. His publications include three books on medieval leprosy (1991, 1996 and 1998)  and three edited volumes:  one on the history of diseases and medical responses from origins to present times (1993), one on the archaeology and architecture of hospitals (2004), and another on measurement in medieval history (2013). In addition to many contributions to edited volumes, he recently published an essay on Ivo of Chartres and the revolution of medieval hospital care (2017) and an important article on the origins of the Faculty of Medicine in Montpellier (2018).

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Notes on contributors

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Magnus Vollset is an Associate Professor in History of Medicine and Researcher in History of Science at the University of Bergen, Norway. His Ph.D.  thesis (2013) examined the transnational history of leprosy, 1840–​1940, and his wider research interest is in how knowledge travels. Vollset has published books on the history of urban infrastructure (2007), meteorology (with Yngve Nilsen, 2016), dentistry (with Håkon Haugland, 2016)  and geophysics (with Gunnar Ellingsen and Rune Hornnes, 2018). Vollset does not own a cat. Kathleen Vongsathorn, D.Phil., is an Assistant Professor of Historical Studies at Southern Illinois University Edwardsville, USA. Her research interests encompass leprosy and other health-​ related topics in twentieth-​ century Uganda, and the history of leprosy in the British Empire. Her publications include ‘Discovering the “leper”: Shifting attitudes towards leprosy in twentieth-​century Uganda’, in J.  Reinarz and K.  Siena (eds), A Medical History of Skin:  Scratching the Surface (2013); and ‘Teaching, learning, and adapting emotions in Uganda’s child leprosy settlement, c. 1930–​62’, in S.  Olsen (ed.), Childhood, Youth and Emotions in Modern History:  National, Colonial and Global Perspectives (2015).

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Acknowledgements

From its inception, this volume has been a deeply collaborative undertaking, and the editors wish to thank a number of individuals and institutional bodies for their assistance and support. The concept for the volume originated at a conference held at King’s College, Cambridge, in April 2011. The conference was financially supported by the Wellcome Trust and King’s College, Cambridge, and the event was made possible through the support of Peter Murray Jones, Librarian of King’s College. At every stage of the development of the volume, from the initial book proposal to submission of the final manuscript, the guidance and advice of David Cantor, editor of the Social Histories of Medicine edited volumes series, has been invaluable. The editors are also most grateful to Meredith Carroll, Thomas Dark and Alun Richards at Manchester University Press, and Lizzie Evans at Newgen Publishing UK, for their expert assistance and work on the volume. A generous subsidy towards the cost of reproducing the images in the volume was provided by the CITERES Equipe Monde Arabe et Méditerranée of the University of Tours, and Anne Bargès of the University of Tours assisted with the index. Elma Brenner is grateful for the support of her colleagues at Wellcome Collection, and to Li-​Xuan Teo, 2019 summer intern at Wellcome Collection, for her assistance with picture research. She also thanks Marylin Brenner for her editorial assistance, and Salvador Alcántara Peláez, Marylin Brenner, Oswin Brenner and Jean Kirkley for their support.

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Acknowledgements

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The editors are most grateful to the anonymous reader of the volume, whose valuable and insightful suggestions have improved the content and coherence of this collection. Finally, a debt of gratitude is owed to the contributors, for their willingness to think deeply about matters of leprosy and identity, and for their patience as the volume came to fruition. We hope that their chapters will inspire others to contribute new knowledge and new perspectives on illness, disability and identity in the past and the present.

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Abbreviations

Demaitre, Leprosy L. Demaitre, Leprosy in Premodern Medicine: A Malady of the Whole Body (Baltimore: Johns Hopkins University Press, 2007) London, BL London, British Library Paris, BnF Paris, Bibliothèque nationale de France Rawcliffe, Leprosy C. Rawcliffe, Leprosy in Medieval England (Woodbridge: Boydell Press, 2006) Touati, Maladie F.-​O. Touati, Maladie et société au Moyen Age: La lèpre, les lépreux et les léproseries dans la province ecclésiastique de Sens jusqu’au milieu du XIVe siècle (Brussels: De Boeck Université, 1998)

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Introduction Elma Brenner and François-​Olivier Touati

Although leprosy, known today as Hansen’s disease, affected only a small minority of people in medieval Europe, its impact on society and culture has left a strong mark in the historical record. Sources as varied as legal documents, saints’ lives, works of art and archaeological data reveal the significance of this disease for European people between the tenth and sixteenth centuries, and either side of this time frame. Research on medieval leprosy in recent decades has challenged the predominant earlier view that sufferers were uniformly excluded and stigmatised, as well as that the disease was highly contagious and constituted an epidemic in medieval Europe. Nonetheless, such perspectives have not completely receded.1 By addressing key questions about the experiences of medieval individuals identified as ‘lepers’, and about responses to leprosy, we are able to gain a better understanding of the complex status of this illness and its sufferers. Although the paucity of narrative accounts from leprosy sufferers themselves can make it difficult to access their experiences, it is sometimes possible to discern their agency and assertion of their own interests.2 Furthermore, cross-​disciplinary approaches shed light on the visual, linguistic, religious, legal and socio-​economic components of the identities of people affected by leprosy. Those people include not only individuals who had the disease, but also the non-​leprous people who lived alongside them in leprosy hospitals, as well as members of their broader social and familial networks, and the medical practitioners who treated them.

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Leprosy and identity in the Middle Ages

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Leprosy in medieval Europe Leprosy is a global disease that has affected people in not only Europe but also India, China, the Americas and other parts of the world in the past, and continues to affect people in certain areas of the world today. The focus here is on western Europe between the eleventh and fifteenth centuries, with case studies from Italy, Germany, France and England. Some of the chapters that follow, by Charlotte Roberts, Luke Demaitre, Rafaël Hyacinthe and François-​ Olivier Touati, provide a broader geographical consideration of leprosy’s social and cultural impact across Europe and beyond, in terms of skeletal evidence (Roberts), iconography (Demaitre) and the aspects of identity bound up with the crusades to the Holy Land (Hyacinthe, Touati). The analysis by Touati provides the earlier medieval context that preceded developments from the eleventh century onwards, and underlines cultural similarities between Europe and the East with respect to leprosy during this earlier period. Anna M. Peterson offers a rare comparative European study, considering examples from two Mediterranean cities, Narbonne and Siena.3 The concluding chapter (Kathleen Vongsathorn and Magnus Vollset) places the legacy of medieval European leprosy in a global perspective, by considering how the understanding of medieval leprosy held by nineteenth-​and twentieth-​ century Europeans influenced their approaches to leprosy in the colonial world, as well as in contemporary Europe. The historical global picture provides a comparative perspective that reveals what was distinctive about the situation in medieval Europe with respect to leprosy.4 In China, at first glance there are similarities with Europe, in terms of the changing terminology for the disease and the emergence of the notion that it was contagious. Much as the biblical terms for leprosy known in Europe from the early Middle Ages signified a range of skin disorders, rather than one illness, the ancient Chinese words associated with the disease, li and dafeng, are non-​specific. From the twelfth century in China a much more specific term emerged, mafeng, signifying a key symptom (ma –​numb) and a defining causal influence (feng –​ wind).5 Similarly, in Europe between the twelfth and fifteenth centuries, medical authors provided an increasingly precise definition of what

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Introduction

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was termed in Latin lepra. Following the Black Death in the mid-​ fourteenth century, in Europe leprosy was increasingly understood to be transmitted via corrupt air, providing an interesting parallel with the Chinese emphasis on the action of the wind in causing the disease.6 By the fifteenth century, leprosy was viewed as a contagious disease in China, adding to the stigma associated with sufferers, especially since it was linked to sexual transmission.7 Similar ideas existed in Europe, bound up with more general anxieties regarding disease transmission following the first outbreak of the plague.8 Institutional provision for leprosy sufferers, however, developed in a very different way in China as compared to Europe. While leprosaria were established outside European towns and cities from the second half of the eleventh century, comparable institutions only appeared in China from the first decades of the sixteenth. Chinese leprosaria were managed by the state, rather than by religious orders, and their residents did not follow a religious way of life. The leprosaria in China were established in response to heightened anxieties about contagion, and a view that sufferers were morally problematic. Unlike their European counterparts, which were located in suburban or semi-​rural settings within reach of major settlements, these institutions were often placed at a very great distance from towns and cities and were not supported through the charity of affluent citizens.9 The European Middle Ages thus mark a distinctive, potentially unique period for the emergence of specialised institutions that did not fully isolate leprosy sufferers from the rest of society, and instead ensured that they remained connected with the Christian community through charity and devotion. The present volume makes a new contribution to our knowledge and understanding of European leprosaria, through not only a section focusing on how these institutions sat at the boundary point between integration and segregation (Part II) but also other chapters (Touati, Damien Jeanne, Peterson) that consider institutional care in relation to diverse questions about leprosy and identity. Furthermore, considerations of extra-​institutional contexts for leprosy (Part III) suggest that in some instances sufferers were excluded from the opportunity to join a leprosarium community, by virtue of factors that could include their social, economic or religious identity.10

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Leprosy and identity in the Middle Ages

The issue of when, and indeed if, leprosy disappeared from Europe has helped to shape the chronological frame of this volume. Certainly, by the seventeenth century, in many parts of Europe few or no cases of leprosy were being confirmed. By the sixteenth century, the official procedure by which suspected sufferers were examined and diagnosed involved physicians and surgeons, as well as sometimes the residents of leprosy hospitals, all of whom can be expected to have had expertise that enabled them to identify the disease. The documentary record testifies to the redundancy of the function of many leprosaria in England, France and Germany from as early as the fourteenth century, with the closure of a number of these institutions in the sixteenth and seventeenth centuries, or their conversion to other charitable functions. The English leprosarium at Winchester, for example, the subject of Simon Roffey’s chapter (Chapter  5), became an almshouse in the sixteenth century. This picture is corroborated by the archaeological record, in which cases of leprosy after c. 1550 are very rare (see Roberts, Chapter 1). In addition, far fewer certificates confirming the outcome of examinations of suspected leprosy sufferers were issued in the seventeenth century in comparison to the previous 200 years. With a sharp decline in the number of examinations taking place, it would appear that cultural and social anxieties about health had definitively shifted to focus on other issues, especially plague and the pox (syphilis, or the ‘French disease’), a ‘new’ disease in later fifteenth-​and sixteenth-​century Europe. It is possible to suggest, based on the material presented in this volume, that leprosy was already in decline by the fourteenth and fifteenth centuries, but that initially it remained at the forefront of people’s health concerns, resulting in continuing public health measures and the appearance of leprosy sufferers in works of art (see Demaitre, Chapter 8) and other types of cultural production. By the seventeenth century, however, leprosy had to a great extent receded from the popular imaginary. Through ancient DNA (aDNA) analysis,11 bioarchaeologists have been able to establish that the strain of leprosy prevalent in medieval Europe persists today in southern states of the USA, very probably transmitted through early European migrations to the New World. The stability of this strain over long periods of time suggests that the decline of leprosy in Europe was almost certainly

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Introduction

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not caused by any genetic change to the leprosy bacillus.12 Instead, it has been suggested that the disease may have declined because of factors that increased the mortality of leprosy sufferers, including poor living conditions; maternal mortality among females; and sufferers’ susceptibility to tuberculosis, cancer and bubonic plague.13 Morbidity removed people with leprosy from the population, thus preventing them from transmitting the disease to others. Nonetheless, leprosy did not disappear completely from Europe, since it affected people in Norway, Iceland, Spain and Greece in the nineteenth century.14 As Vongsathorn and Vollset demonstrate in Chapter 12, concerns about the presence of leprosy in Europe at this time caused physicians to take a significant interest in medieval leprosy, and affected the colonial encounter with leprosy in other parts of the world.15 As well as shedding light on the issue of the European decline of leprosy, recent archaeological work facilitates consideration of how the disease spread within medieval Europe, and of its physical impact upon the bodies of sufferers. A fifth-​to-​sixth-​century male skeleton from a cemetery at Great Chesterford, UK, has been shown through both osteological and aDNA analysis to have been affected by leprosy. Isotope analysis indicated that this male probably originated from outside the UK, in Germany or Denmark. The strain of leprosy detected in the skeletal remains has been found in Denmark and Sweden, as well as the UK. It is therefore possible that this man brought leprosy with him when he migrated, and that he was thus one of the vectors for the disease’s presence in Anglo-​Saxon England.16 A broad-​ranging aDNA study of leprosy in skeletons from early medieval eastern and central Europe revealed that strains of leprosy in these regions were similar to those in modern Asia Minor, as opposed to those in medieval north-​western Europe. This evidence confirms that there was a range of strains of leprosy in medieval Europe as a whole, and suggests that migration from central Asia after the fall of the Roman Empire introduced some of these strains to Europe.17 Osteology and palaeopathology are the starting points for aDNA research into medieval leprosy, since aDNA is investigated in skeletons that have the bone changes symptomatic of leprosy.18 The careful study of such changes, principally affecting the bones of the face, hands and feet, can indicate the extent to which the disease

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Leprosy and identity in the Middle Ages

affected a person’s physical appearance and mobility, both of which factors impacted upon their identity. Consideration of the context within which leprosy sufferers were buried, in terms of a burial’s position within a cemetery, the type of cemetery, and the presence or absence of a coffin and/​or grave goods, can also be indicative of status and identity. The chapters by Roberts and Roffey in this volume reveal the richness of such data derived from archaeology and palaeopathology, and that data’s ability to provide insights that cannot be derived from the documentary record.

Terminology While aDNA reveals the global distribution of Hansen’s disease, it does not shed light on the cultural significance of leprosy in the past, and on how cultural conceptions of the disease impacted upon identities. Language, as a fundamental medium through which identity is constructed and expressed, enables us to gauge past perceptions and experiences of disease and disability, and how these perceptions and experiences shaped identities. Recently researchers have paid careful attention to the terminology that medieval people used in relation to illnesses and physical and mental disabilities.19 This approach creates an increasingly nuanced picture, to which several authors in this volume, such as Lucy Barnhouse (Chapter 7), make important further contributions. Barnhouse’s exploration of vernacular terms denoting leprosy and leprosy sufferers in late medieval Germany sheds light on the range of statuses of sufferers, and on how, in the past, language communicated certain social expectations about the proffering of compassion and charity to people with leprosy. As a whole, this volume provides a consideration of the treatment of leprosy and leprosy sufferers in both Latin, the language of the Church and of learning in the Middle Ages, and vernacular languages, enabling comparison of different linguistic registers and geographical contexts, and evaluation of change in terminology over time. Language remains a highly sensitive issue in relation to leprosy today, since the word ‘leper’ can often denote stigma, marginality and exclusion, and can be used to denigrate those who have the disease. The euphemistic phrase ‘he/​she is/​was treated like

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Introduction

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a leper’ signifies the broadly held notion that sufferers are shunned and excluded from society (in the past and/​or the present). In 1947 it was established at the International Leprosy Congress in Brazil that there should be international agreement to avoid calling a person with leprosy a ‘leper’, designating that person instead a ‘leprosy patient’. It was stated that the word ‘leprosy’, on the other hand, ‘should be retained as the scientific designation for the disease’, although other regional, popular terms could also be used if they promoted understanding of the advances made in the diagnosis and treatment of leprosy.20 Leprosy charities today continue to advocate for a complete avoidance of the use of the word ‘leper’.21 The authors in this volume take varied approaches to the issue of terminology. Several contributors, including Carole Rawcliffe, Barnhouse and Peterson, do elect to deploy the term ‘leper’, since this enables them closely to translate the words leprosi, Aussätzigen or lépreux in their documentary sources. Their approach is also influenced by the fact that, when medieval documents refer to ‘lepers’, we cannot always be certain that the individuals described were actually suffering from Hansen’s disease; nonetheless, they were considered to be a ‘leper’ by the society in which they lived. It is worth bearing in mind too that ‘leper’ and also ‘leprosy’ had metaphorical as well as literal meanings in the Middle Ages. Other contributors, however, such as Demaitre, Elma Brenner, Roffey and Roberts, avoid the term ‘leper’, as they are unwilling to perpetuate the use of a term that is stigmatising in the present and sometimes also denoted stigma in the past. They consider alternative terms such as ‘leprosy sufferer’ and ‘leprosy patient’ to be far preferable. These different positions underline the fact that decisions about terminology when writing about leprosy in the Middle Ages are far from straightforward. Above all, we need to remain highly sensitive to the implications of the language that we use when communicating about this disease, and indeed other illnesses and disabilities in the past.

Identities The question of identity, in terms of how the sick and disabled were viewed by themselves and others in the Middle Ages, and how they and others identified their physical or mental condition, is also highly

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Leprosy and identity in the Middle Ages

relevant to leprosy.22 As Roberts observes in Chapter 1, a person’s identity has many different components, and the personal aspects of identity, such as biological sex and age, are usually entwined with the socially determined aspects, such as religion and occupation. The diverse aspects of identity may lead a person to form part of a range of communities and social networks simultaneously, such as the parish community, the extended family and the professional corporation.23 In many instances, the identities of medieval people were transformed when they contracted leprosy, through changes to their physical appearance, mobility and ability to practise a profession, as well as through their transferral to a leprosy hospital community where they assumed a quasi-​religious status.24 At the same time, people with leprosy retained important aspects of their previous identity, such as membership of familial and friendship networks and, as Brenner’s chapter on dietary entitlements within leprosaria shows, elevated religious or social status. In terms of biological sex and age, most of the examples in this volume concern adult males affected by leprosy, as these are more prominent in the historical and archaeological record than examples of adult women or children of either sex. Demaitre notes that only male leprosi appear in images depicting clappers; the Order of Saint Lazarus, discussed by Hyacinthe (Chapter 10), catered exclusively for adult men. Yet women and young people are far from being completely absent from this volume, and when they do appear the discussion points the way to the rich potential for further research on leprosy, gender and the life cycle. Among the miracles of Thomas Becket surveyed by Jeanne appear both the mother of a leprous boy or young man, in a care-​giving role, and a leprous oblate within a monastery, presumably also a young man. Burials excavated at the leprosarium of Saint Mary Magdalen, Winchester, described by Roffey, were mainly adult males, but included a mature adult female and a young female child. These glimpses suggest that our consideration of leprosy and identity must encompass men and women; young, adult and advanced in age; both those suffering from the disease and those affected by it as the relatives, carers, fellow community members, patrons and friends of the sick. Identities may be both individual and collective. These two forms of identity are also entwined, since a person’s sense of themselves may be shaped to a great extent by the identity that they share

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Introduction

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with other members of a group or community. As is the case for people affected by other illnesses or disabilities part-​ way through their lives, people with leprosy may experience a changed relationship with their own self, feeling estranged from their new identity and even disapproving of their own symptoms and altered physical appearance. Upon joining a hospital community of fellow leprosy sufferers, a person may feel ambivalence, but also a sense of stability and support, especially if that community has its own strong identity grounded in traditions and a structured way of life.25 Collective identity is an important theme with respect to medieval leprosy sufferers, since many of them gathered together in groups. Peterson argues in Chapter 11 that becoming part of a community was fundamental to the experience of having leprosy: ‘lepers moved from the singular to the plural’.26 Even though leprosy sufferers were members of communities (the family, the parish) prior to developing the disease, once they had leprosy their status as members of collectivities arguably became more dominant vis-​à-​ vis their individual identities. A  number of the leprosy hospitals that emerged in the twelfth century, such as Mont-​aux-​Malades at Rouen, are believed to have originated as informal groupings that were subsequently organised as religious communities.27 Indeed, Canon 23 of the Third Lateran Council of 1179, providing for groups of leprous people to have their own church, cemetery and priest, offered an official ecclesiastical mandate for this organisational process.28 As Barnhouse’s examples from the Rhineland show, during and after the wave of foundations of leprosaria in the twelfth and thirteenth centuries, people with leprosy continued to form less formal, often itinerant groups, some of which became settled on a particular site. The collective identities of groups of leprosy sufferers, within and outside institutional settings, could be reinforced through visual and material culture, as well as through shared customs and rituals. The clapper was a particularly important artefact associated with people with leprosy, as shown by Demaitre’s extensive analysis, and Hyacinthe’s discussion of the presence of the clapper on the seal of the crusading order of Saint Lazarus (Figure  10.1). It is evident that leprosy sufferers identified with each other, as a result of shared experiences and, perhaps, the fact that they were familiar with the disfiguring and disabling effects of the disease and could

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Leprosy and identity in the Middle Ages

exchange support and advice. In this sense, the formation of leprosy communities reflects the agency and actions of sufferers themselves, as well as the external intervention of religious and secular authorities. While collective identity was intrinsic to the relationships of people with leprosy with each other, it also influenced their links with non-​ leprous individuals. The overall community of the leprosarium consisted of both leprous and non-​leprous persons, since professed monks and nuns, lay brothers and sisters, and servants lived alongside the sick. Although community life was often segregated, according to gender as well as state of health, the community as a whole had a shared identity, a fact underlined by the language of donation charters, issued to the whole community, both healthy and sick, of the leprosarium. Analysis of certain aspects of community life, such as the study of dietary provision and eating practices within leprosy hospitals provided by Brenner in this volume (Chapter 6), sheds light on the factors that promoted or discouraged the ability of all members of these communities to share in a single identity. Hyacinthe’s chapter on the order of Saint Lazarus (Chapter 10) explores how shared identity operated within another kind of religious community, a military fraternity engaged in the Christian effort to reconquer Jerusalem. The order of Saint Lazarus incorporated both leprous and non-​leprous knights, and enabled knights who contracted leprosy to retain their military identity. In certain instances leprous knights may have gone to battle, indicating that they were sufficiently fit to do so. Indeed, the physical effects of leprosy vary from person to person and often take time to develop. When considering identity, we also need to remind ourselves that those medieval people who were labelled and categorised as leprosi were not necessarily suffering from leprosy. The disease was sometimes conflated with other skin disorders, and some residents of leprosy hospitals willingly took on the identity of the leprosus in order to benefit from the accommodation, sustenance and community life offered by these institutions. There could also be pious motives for choosing to live as a leprosus or in close proximity to leprosy sufferers. Particularly in the twelfth and thirteenth centuries, leprosy was perceived as a divinely inflicted illness that resulted in the sufferer’s salvation, and the links between the leprous and Christ and the saints were emphasised. The theme of kissing

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Introduction

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people with leprosy, prominent in medieval hagiographic and other writings, probed the dichotomy between disgust at the appearance of leprous faces, and desire for close physical contact with holy bodies.29 In Chapter 9, Courtney A. Krolikoski charts a particularly strong and influential narrative of the thirteenth century:  that of Saint Francis of Assisi’s intimate interactions with the leprous. In some instances, both genuine sufferers and individuals who may not have had the disease actively embraced the salvific and material opportunities offered by the identity of the leprosus.

Between integration and segregation Within leprosy hospitals, a key aspect of the identities of persons with leprosy was their religious or quasi-​ religious status. As Rawcliffe shows in Chapter  4, this Christian identity not only united the leprous and non-​leprous members of the leprosarium community, but also extended beyond the institution’s walls. The believed capacity of people with leprosy to intercede effectively for the souls of others through their prayers resulted in the formation of spiritual confraternities, linking the leprous to their benefactors in wider society. These communities of prayer included both the living and the dead, and symbolised the full integration of leprosy sufferers into the spiritual world of Christian society.30 Nonetheless, in many respects the residents of leprosy hospitals were segregated from the rest of society. Unlike medieval hospitals for the acutely sick, leprosaria provided long-​term care, with the chronically sick residents becoming permanent members of the community. Roffey’s account of archaeological findings on the site of the leprosarium of Saint Mary Magdalen, Winchester, describes the extensive infrastructure of a larger hospital, and shows how the buildings were modified over several centuries. Like the communities at large suburban or rural monasteries, the residents of this hospital and other leprosaria were able to live in a largely self-​ sufficient manner. The regulation of leprosaria and leprosy sufferers by ecclesiastical and secular authorities sheds further light on the issue of segregation. Peterson in Chapter 11 shows that, as early as the 1260s and probably already in the 1240s, municipal authorities in Siena legislated for the removal of people with

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Leprosy and identity in the Middle Ages

leprosy from the city to one of the leprosaria. Nonetheless, leprosy sufferers were permitted inside the city walls during Holy Week, no doubt in order to receive alms. As Peterson argues, these measures point towards a wish to gather leprosi together as a group, and to prevent people with leprosy from pursuing individual existences. The movement and activities of the group could more easily be monitored and controlled, in terms of public health concerns as well as the distribution of charity. Segregation itself was not necessarily a negative concept with respect to leprosy, since it entailed the sick person’s entry to a supportive community where they received bodily and spiritual care, as well as gaining the opportunity to pursue a devout way of life. Jeanne’s Chapter 3 survey of miracles of Thomas Becket in which leprosy sufferers feature reveals that the language of separation and segregation in these miracle accounts, written down in Latin by Benedict of Peterborough and William of Canterbury in the 1170s, is more ‘soft’ than forceful. This suggests that the manner in which people with leprosy were moved, or moved themselves, from their homes to other contexts, here a leprosarium or Becket’s shrine, was not an enforced or violent process. The distribution of Christian charity to people with leprosy, especially to the residents of leprosaria, most clearly demonstrates that segregation and integration sat side by side. As Demaitre shows in Chapter 8, the clapper provided leprosy sufferers, whose own vocal capacity was often diminished, with a voice with which to solicit alms and communicate more broadly. In some instances, that voice was transferred to their non-​leprous representatives who carried the clapper and acted on their behalf. The vocalisation of a demand or entreaty for beneficence underlines the agency and proactivity of persons with leprosy. Since the narrative perspectives of people with leprosy are so often absent from documentary sources such as accounts of leprous kisses,31 especial attention needs to be paid to indicators that leprous people did express individual and collective voices.

Overview Together, the chapters in this volume shed new light on the identities and experiences of people affected by leprosy in medieval western Europe, whether they had the disease themselves or interacted

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Introduction

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closely with sufferers. The chapters also show that, over several centuries, there was much diversity within a relatively small geographical region in terms of how people with leprosy were cared for, controlled and perceived by others. Part I, ‘Approaching leprosy and identity’, introduces the subject with broad geographical surveys from archaeological (Roberts) and historical (Touati) perspectives, and a consideration of the ambivalent identities of leprosy sufferers through analysis of accounts of miracles (Jeanne). In Part II, ‘Within the leprosy hospital: between segregation and integration’, the institutional context for leprosy is examined, especially in terms of community life and the development and infrastructure of leprosaria. While Rawcliffe considers the special spiritual role of leprosy sufferers as intercessors for their benefactors in medieval England, Roffey presents vital new archaeological evidence for the emergence and function of the English leprosarium at Winchester, and Brenner explores how dietary arrangements within leprosy hospitals in northern France reflect identity. Part III, ‘Beyond the leprosy hospital:  the language of poverty and charity’, addresses the status and experiences of leprosy sufferers outside the institutional setting. Barnhouse, discussing evidence from the late medieval Rhineland, finds that sufferers lived together in informal groupings as well as in hospital communities, and that in both cases they retained aspects of their previous social identities. Demaitre provides a much-​needed analysis of the clapper, the key attribute of the begging leprosus, revealing the complex visual language of leprosy and the dynamics of poverty and charity in spaces and places across Europe. The identities of the leprous are considered further in Part IV, ‘Religious and social identities’. Krolikoski examines the hagiography of Saint Francis to explore the special connections of this saint with leprosy. Her discussion helps us to understand why leprosy sufferers were such a strong focus of Christian charity, and the way in which religious connotations shaped how they were viewed by others. Hyacinthe’s chapter adds to this picture of religious identities by surveying the complexity of identity among the knights of the Order of Saint Lazarus, who were both leprous and non-​leprous. The comparative study of responses to leprosy in Narbonne and Siena provided by Peterson sheds light on social identities, reflecting on how broader political and social factors shaped the construction of the identities of the leprous.

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Leprosy and identity in the Middle Ages

Part V, ‘Post-​ medieval perspectives’, examines how leprosy in medieval Europe has been perceived in more recent times. Vongsathorn and Vollset’s chapter considers how encounters with the disease in the colonies in the nineteenth and early twentieth centuries encouraged physicians, writers in the popular press and others to seek information about the impact of leprosy in the European past. This analysis, showing that people investigating the history of the disease were influenced by their own agendas and anxieties, encourages us to be aware today of how our own preoccupations shape our study of medieval leprosy, as well as other diseases and health issues in the past. The different disciplinary and methodological approaches presented in this volume provide an exciting impetus for fresh work to be done on all aspects of health and disability historically, while retaining a critical awareness of how such work can be affected by cultural and social factors in the present. Furthermore, the findings presented here have the potential to enhance our understanding of matters of health and illness in the modern world, since they reveal the complexity of the identities of people affected by a chronic, disfiguring and symbolic disease.

Notes 1 For the perpetuation of the earlier view, see S. Zimmerman, ‘Leprosy in the medieval imaginary’, Journal of Medieval and Early Modern Studies, 38 (2008), 559–​63 (arguing that medieval responses to leprosy were predominantly negative); T. S. Miller and J. W. Nesbitt, Walking Corpses:  Leprosy in Byzantium and the Medieval West (Ithaca, NY: Cornell University Press, 2014), p. 2 (on leprosy as an epidemic). 2 See J. Stemmle, ‘From cure to care: Indignation, assistance and leprosy in the high Middle Ages’, in A. M. Scott (ed.), Experiences of Charity, 1250–​1650 (Farnham: Ashgate, 2015), pp. 45–​7, 50–​3. Gaining insights about the experiences and perspectives of leprosy sufferers is also challenging in more recent historical contexts, especially in European colonial settings:  S. Snelders, Leprosy and Colonialism:  Suriname under Dutch Rule, 1750–​1950 (Manchester:  Manchester University Press, 2017), pp. 8–​11. 3 A recent doctoral study by Katie Phillips also provides a comparative European perspective:  K. Phillips, ‘The leper and the king:  The patronage and perception of lepers and leprosy by King Henry III of

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Introduction

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England and King Louis IX of France’, Ph.D. dissertation (University of Reading, 2018). 4 The 2018 conference ‘Leprosy and the “Leper” Reconsidered’ at McGill University provided an opportunity for global considerations of leprosy in history. A volume of essays resulting from the conference, Leprosy from the Medieval to the Modern World: A Global Interdisciplinary edited by C. A. Krolikoski and Approach, is in preparation, co-​ A. M. Peterson. 5 A. K. C. Leung, Leprosy in China: A History (New York: Columbia University Press, 2009), pp. 4, 18. 6 E. Brenner, ‘Recent perspectives on leprosy in medieval Western Europe’, History Compass, 8 (2010), 388–​406 (p. 391). 7 Leung, Leprosy, pp. 5, 58–​9. 8 On leprosy and contagion, see F.-​ O. Touati, ‘Contagion and leprosy: Myth, ideas and evolution in medieval minds and societies’, in L. I. Conrad and D. Wujastyk (eds), Contagion: Perspectives from Pre-​Modern Societies (Aldershot: Ashgate, 2000), pp. 179–​201. 9 Leung, Leprosy, pp. 96–​8,  100–​1. 10 Jewish and Muslim leprosy sufferers, for example, could not enter Christian leprosaria. On the situation of Jewish people with leprosy in medieval Europe, see E. Shoham-​ Steiner, On the Margins of a Minority:  Leprosy, Madness, and Disability among the Jews of Medieval Europe, trans. H. Watzman (Detroit: Wayne State University Press, 2014); F.-​ O. Touati, ‘Domus judaeorum leprosorum:  Une léproserie pour les juifs à Provins au XIIIe siècle’, in J. Dufour and H. Platelle (eds), Fondations et oeuvres charitables au Moyen Age (Paris: CTHS, 1999), pp. 97–​106. Despite these valuable studies, more work remains to be done about how Jewish and Muslim communities in Europe provided for people with leprosy. 11 Elma Brenner is grateful to Helen D. Donoghue for discussing aDNA research with her and suggesting recent publications in the field to consult. aDNA research has also shed much light on the global reach, transmission and impact of the bacterium responsible for the Black Death, Yersinia pestis:  see M. H. Green, ‘Taking “pandemic” seriously:  Making the Black Death global’, in M. H. Green (ed.), Pandemic Disease in the Medieval World: Rethinking the Black Death (Kalamazoo: Arc Medieval Press, 2015), pp. 27–​61, and other chapters in Green, Pandemic Disease. 12 S. A. Inskip, G. M. Taylor, S. R. Zakrzewski et  al., ‘Osteological, biomolecular and geochemical examination of an early Anglo-​Saxon case of lepromatous leprosy’, PLOS One, 10(5):  e0124282 (2015), 1–​2, 16. DOI: 10.1371/​journal.pone.0124282.

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13 J. Blondiaux, S. Naji, J.-​ P. Bocquet-​ Appel et  al., ‘The leprosarium of Saint-​ Thomas d’Aizier:  The cementochronological proof of the medieval decline of Hansen disease in Europe?’, International Journal of Paleopathology, 15 (2016), 140–​51; Inskip et  al., ‘Osteological, biomolecular and geochemical examination’, 1–​2. 14 R. Edmond, Leprosy and Empire:  A Medical and Cultural History (Cambridge:  Cambridge University Press, 2006), pp. 7–​8; Kathleen Vongsathorn and Magnus Vollset, Chapter 12 in this volume. 15 On European colonial encounters with leprosy, see, for example, Edmond, Leprosy and Empire; Snelders, Leprosy and Colonialism. 16 Inskip et al., ‘Osteological, biomolecular and geochemical examination’, pp. 1–​18. 17 H. D. Donoghue, G. M. Taylor, A. Marcsik et al., ‘A migration-​driven model for the historical spread of leprosy in medieval Eastern and Central Europe’, Infection, Genetics and Evolution, 31 (2015), 250–​4. DOI: 10.1016/​j.meegid.2015.02.001. 18 Ibid., 251. 19 I. Metzler, A Social History of Disability in the Middle Ages: Cultural Considerations of Physical Impairment (New York: Routledge, 2013), pp. 4–​5; I. Metzler, Fools and Idiots? Intellectual Disability in the Middle Ages (Manchester:  Manchester University Press, 2016), pp. 230–​1; W. J. Turner, Care and Custody of the Mentally Ill, Incompetent, and Disabled in Medieval England (Turnhout: Brepols, 2013), pp. 5–​7. 20 ‘Leprosy news and notes’, International Journal of Leprosy, 16 (1948),  243–​4. 21 See S. Roffey, Chapter 5 in this volume (n. 2). 22 See E. Brenner, ‘Leprosy and identity in the Middle Ages’, in M. Jackson (ed.), The Routledge History of Disease (London: Routledge, 2016), pp. 461–​73. 23 J. L. Stevens Crawshaw, ‘Introduction’, in A. Spicer and J. L. Stevens Crawshaw (eds), The Place of the Social Margins, 1350–​ 1750 (New York: Routledge, 2017), p. 4. 24 Acquired disfigurement, occurring suddenly in adulthood as a result of violence, similarly ‘had the potential to destroy or severely damage a pre-​ existing, and established, social identity.’ P. Skinner, Living with Disfigurement in Early Medieval Europe (New  York:  Palgrave Macmillan, 2017), p.  6. Skinner (pp.  5–​ 7) distinguishes between acquired disfigurement, congenital disfigurement and ‘the progressive disfigurement brought about by disease, in particular leprosy’. 25 See E. Goffman, Stigma: Notes on the Management of Spoiled Identity (Harmondsworth: Penguin, 1968), pp. 45–​52. 26 A. M. Peterson, Chapter 11 in this volume, p. 327.

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27 E. Brenner, Leprosy and Charity in Medieval Rouen (Woodbridge: Boydell Press, 2015), p. 20. 28 N. P. Tanner (ed. and trans.), Decrees of the Ecumenical Councils, 2 vols (London: Sheed & Ward, 1990), Vol. I, pp. 222–​3. 29 C. Peyroux, ‘The leper’s kiss’, in S. Farmer and B. H. Rosenwein (eds), Monks and Nuns, Saints and Outcasts:  Religion in Medieval Society:  Essays in Honor of Lester K.  Little (Ithaca, NY:  Cornell University Press, 2000), pp. 172–​88; J. Orlemanski, ‘How to kiss a leper’, postmedieval: A Journal of Medieval Cultural Studies, 3 (2012), 142–​57. 30 Also see C. Rawcliffe, ‘Communities of the living and of the dead: Hospital confraternities in the later Middle Ages’, in C. Bonfield, J. Reinarz and T. Huguet-​Termes (eds), Hospitals and Communities, 1100–​1960 (Oxford: Peter Lang, 2013), pp. 125–​8. 31 Orlemanski, ‘How to kiss a leper’, pp. 143–​4: ‘medieval representations of the kiss are generally one-​sided, focusing almost exclusively on the experience of the devout and able-​bodied osculans’.

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Part I

Approaching leprosy and identity

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Reflections on the bioarchaeology of leprosy and identity, past and present Charlotte Roberts Leprosy is an infectious disease caused by a bacterium, Mycobacterium leprae or lepromatosis. It is transmitted to humans via the respiratory route through inhalation of bacteria-​ laden droplets from the lungs of an infected person. Leprosy affects the skin, nerves and other parts of the body, including the skeleton, but the way the body is affected will depend on the type of leprosy a person experiences, along leprosy’s immune spectrum.1 People with low resistance to leprosy will most probably contract lepromatous leprosy, or the type of leprosy that is usually reflected in skeletons from archaeological sites. People with high resistance contract tuberculoid leprosy; these would be the people we would not necessarily recognise so easily in the archaeological record and they may not even have any bone changes. Based on the evidence relating to ‘new cases’, today leprosy remains a challenge to manage in Brazil, India, and in some parts of Africa and southeast Asia. The modern perception, certainly in ‘developed’ areas of the world, is that it has been ‘conquered’, because the number of new ‘cases’ is low.2 However, people in many parts of the world continue to experience the consequences of the disease, even after they have been officially ‘cured’. Surprisingly, the history of leprosy remains shrouded in mystery and infiltrated with myths promulgated by nineteenth-​ century writers, myths that are beginning to be dispelled as scholars re-​evaluate the evidence of the past.3 It has been suggested that people with leprosy in the European medieval period (twelfth–​sixteenth centuries CE) suffered socially because of the associated stigma, and were ostracised wholesale from their communities into leprosy hospitals. This idea is now increasingly unsupported, even though it is well known that leprosy-​related stigma remains very apparent

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today.4 This chapter addresses some of the key questions we still have about how people lived their lives with leprosy in the past, and the responses of individual people and their communities to leprosy. In doing so it aims to contribute to a better understanding of the complex nature of leprosy and of the experiences of the people affected by it.

The social consequences of leprosy, and the present and past of identity What is particularly defining about people who experience leprosy, past and present, is the social consequences of the disease for the lives of those affected. Relevant to this is how leprosy can define a person’s identity –​identity basically being described as personal and social –​but overall reflecting the characteristics that make a person an individual and unlike any other human being. Of course, people without leprosy can have the same and different characteristics: for example, two people may be biologically male and of the same age, but their genetic profile will be different, and they may do different work and have different religious affiliations. All these ‘identity variables’ will affect what diseases people contract and, specifically in terms of religion for example, how they may cope with those diseases and what care may be available to them.5 Personal identifying characteristics such as age, biological sex, ancestry, genetic profile and overall health are very much interlinked with the social aspects of a person’s identity, such as their status, ethnicity, occupation, religion, political and social-​system affiliation, gender, and the presence or absence of impairment. These social aspects are also encompassed within the economic system and diet they experience; the local and general environment and climate in which they live; trade and consequent contacts, along with their mobility; and whether they have access to health care. Particularly relevant to this chapter is a person’s social system, as well as the religion that he or she practises, both of which can determine how a person is to be ‘managed’ at their death. While exploring the relationship between aspects of identity and the health problems experienced by individuals is easier to explore in living populations, this is not the case when looking to

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the past. Indeed, as many scholars have emphasised, in studies of archaeological (human) skeletal remains (bioarchaeology) there can often be a focus on just one or a few ‘identity’ characteristics, for example biological sex, gender and social status, rather than looking at the ‘bigger picture’.6 There has also been some debate about when and where the use of the word ‘identity’ first started to occur in bioarchaeological research. However, some conclude that bioarchaeologists have always considered aspects of ‘identity’  –​ as outlined above –​when interpreting data from human remains, including the evidence for disease; it is just that they have not tended to use the word until fairly recently!7

The complexities of identity It should be remembered that ‘Identities are socially constructed, situational, and fluid.’8 Therefore, when considering the relationship between identity and leprosy, it is necessary to be holistic in approach because 1 as we have seen, many features comprise a person’s identity 2 personal and social aspects of identity are usually intimately entwined and often cannot be separated out from each other. For example, although clinical data suggest that leprosy affects men more than women (e.g. only 38.8 per cent of new ‘cases’ in 2015 were women),9 there are many factors that might lead to these figures. For example, women with leprosy in India today (compared to men) may experience later diagnosis (and treatment) because of their social role in the family, and experience much more severe social consequences of being diagnosed with the infection. Thus, delayed treatment may lead to impairment, ‘disability’, marginalisation, poverty, loss of employment, or even their partner. One study of women in India found that they were generally poorly educated, were isolated and lived in poor conditions, and therefore were at a high risk for leprosy.10 The authors of another study found that most women in their analysis, also in India, did not have a basic knowledge of leprosy and did not understand the cause and spread of the disease.11 Additionally, certain age groups are more susceptible to developing leprosy. Today in endemic areas there is a peak in

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frequency between 10 and 14  years of age, and then another rise from about 30  years onwards, the latter age category having the highest frequency.12 That all said, it is poverty that is a major driver for leprosy today; some research has found that people with leprosy are undernourished compared to control groups without leprosy, and this can be related to poverty.13 In relation to occupation, a study of productivity loss due to deformity in leprosy in India found that 30 per cent of men and 60 per cent of women with leprosy were less likely to be employed compared to a control group, and that men earned 14 per cent (and women 38 per cent) less than the controls, even though they worked the same number of days.14 A  study of whether employment influences how impairments develop and compromise activity in people with leprosy highlighted that there were specific impairments that affected what jobs people could do.15 Of course, personal identifying characteristics are usually intrinsic and cannot be easily changed: for example a person’s biological sex; their unique genetic profile, which may make them more or less susceptible to disease; and their ancestry. For example, one study has documented the genes that influence the immune response to the leprosy bacterium and subsequent infection.16 However, socially identifying characteristics can alter through a person’s life course, and factors that change may include their occupation and status, but all these social variables will potentially generate risk factors for the development of health problems. While various aspects of identity have been considered above, it should be emphasised from the outset, and contrary to the stated need to take a holistic approach to identity, that this chapter will not be considering all the features that make up ‘identity’ with respect to people with leprosy. It will focus on what treatment of people with leprosy at the time of their death tells us about how they were viewed by their community.

Bioarchaeological studies of leprosy and identity There have actually been few studies that have specifically explored identity and leprosy in bioarchaeology, for example challenging the traditional view that all those with leprosy were admitted to a leprosarium, with or without associated stigma, and buried in the associated cemetery,17 but in recent years there has been a change in focus of research.18 Taking a clinical approach towards

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understanding leprosy is an essential base from which to explore the history of this infection, and to consider how it has shaped the experiences and identities of people in the past. The chapter will now focus on skeletons of people who were buried during the late medieval period in Europe and beyond that show evidence for leprosy. It aims to challenge the traditional view of the ‘management’ of leprosy in past communities, that of stigma-​related ostracism. It first discusses how leprosy affects the skeleton; its traditional diagnosis in palaeopathology, a component of bioarchaeology (and the limitations of diagnosis); and also the contributions of ancient DNA (aDNA) analysis. It then considers some of the skeletal evidence of leprosy, in combination with accompanying funerary contextual data, and provides a commentary on what this evidence suggests about the identities of the people affected and the attitudes of their communities to them. Utilising studies from medical anthropology, history and clinical medicine, alongside the skeletal data from archaeological sites, the chapter draws attention to how re-​evaluation of data, contextualisation and consideration of alternative views on leprosy’s management in the past can be revelatory. Using the past to help understand the present and future of leprosy is the chapter’s ultimate aim.

Detecting people with leprosy through their skeletal remains: the palaeopathology of leprosy If archaeology is defined as the study of people, then their skeletal remains are the closest we get to understanding the lives of our ancestors, not least because people created the material record of the past. Furthermore, poor health affected the very functioning of society in the past, as it does today. Therefore, studying the health and wellbeing of our ancestors seems to be a compelling way to understand past societies, and provides a deep time perspective  –​ i.e. palaeopathology provides a view of the history of disease over hundreds and thousands of years. The primary evidence for the origin, evolution and history of diseases is found in the remains (mainly skeletons) of once-​living people from funerary contexts excavated by archaeologists.19 This is notwithstanding other evidence that can be found in historical documents, and via artworks that depict people with disease.20 While all classes of evidence for past human

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disease must be considered in reconstructing our disease history, all forms also have their limitations.21 Human remains undoubtedly provide direct evidence of disease, but that evidence can be challenging to interpret. At the same time, in terms of the evidence provided by texts and artworks, we should remember that authors and artists may be biased in their depictions of disease, tending to depict the more dramatic and less common manifestations of sickness. Furthermore, in all sources of evidence, non-​specific signs and symptoms could represent a range of diseases.

The bone changes What bone changes would we expect to see and how would they have affected a person’s identity? The bone changes of low-​ resistance lepromatous leprosy were first described by the Danish doctor Vilhelm Møller-​ Christensen (1903–​ 88).22 His major contribution to palaeopathology was his monumental work on skeletons excavated from a medieval Danish cemetery at Naestved, on the island of Zealand, associated with a leprosy hospital. This research highlighted leprous bone changes to leprologists for the first time, providing a very good example of how the dead can teach the living. The diagnostic features have been developed since then, particularly by Andersen and Manchester,23 and the bone changes of high-​resistance tuberculoid leprosy, at the other end of the immune spectrum, have been suggested by Matos.24 The early signs of leprosy comprise skin lesions and nerve damage, both features that are not seen directly if the skeleton is the evidence being considered. Nevertheless, ulcers on the skin as a response to sensory nerve damage may leave their mark on the underlying bone. Today, skin lesions are often used for diagnosis, alongside evidence of bacteria in those lesions. However, the secondary effects of nerve damage may also be observed in the skeleton (see below). As the leprosy bacteria are inhaled into the respiratory system through the mouth and nose, damage to the bones of the face ensues, and this damage particularly involves the bony structures of the nose and mouth areas. The bacteria cause inflammation in the soft tissues of these areas of the skull, and the underlying bones can then become affected. Ultimately, the opening in the skull for the nose becomes wider, and the edges of the nasal bones

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lose their sharpness and become rounded. The bone of the upper jaw loses depth underneath the nose, the ‘spine’ at the front of the nose absorbs, and the incisor teeth at the front of the jaw can fall out prematurely (Figure  1.1). The bone (palate) that divides the

A

B

C

Figure 1.1  Skull of a medieval person with leprosy, showing: (A) widening of the nasal aperture (‘nose opening’); (B) loss of the anterior ‘spine’; (C) loss of the front teeth (incisors).

Figure 1.2  Damage to the nasal structures of the face in a person with leprosy.

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nose and the mouth can also become inflamed, and destructive lesions (holes) may develop, while the air-​filled cavities of the face (sinuses) can become inflamed, as can the ear structures, including the bones within them. When viewed from the side, and as a result of destruction of the nasal bones, the face appears to have a ‘dished’ appearance (Figure 1.2). The nose is congested, and smell and taste can be affected, which may alter appetite. A person with leprosy is probably very conscious of their facial appearance (and any skin lesions they may have), and a community would likewise notice this appearance (Figure 1.3). The bacteria also affect the nervous system. The nerves responsible for enabling a person to sense things such as pain (sensory nerves); those that convey messages from the central nervous system to stimulate muscles to contract (motor nerves); and those that serve internal organs, including blood vessels (autonomic nerves), are all potentially affected. Loss of the sense of touch is a particular problem, as people cannot feel when their feet and hands are being damaged. The soles of the feet can be traumatised if the person does not wear shoes, and the hands can be burnt if protective gloves are not worn; ulceration can ensue and the underlying bones may be affected. Thinking about people with this type of damage to their bones in the past, we might reflect on whether they came to understand that they needed to protect their hands and feet from further injury because they could not ‘feel’ them (and had already developed damage), and that if they did make those efforts they would not develop further ulcerations. This would most probably have been a learning exercise, including developing adaptive responses. Impacts on each type of nerve can lead to further consequences for a person affected by leprosy. Sensory nerve involvement can lead to ulcers of the hands and feet and consequent damage to the hand and foot bones, motor nerve damage may result in deformities of the hands and feet, and autonomic nerve damage can cause loss of bone in the digits of the hands and feet (Figure 1.4). Today, it is imperative that diagnosis of leprosy occurs early, thus preventing this type of damage and consequent impairment and potential stigma. Visually, the joints of the fingers and toes becoming ‘fixed’/​‘bent’ with these hand and foot deformities is often identified as an early sign of leprosy by communities today, and extensive loss of bone

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Figure 1.3  Twenty-eight-year-old woman with leprosy.

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Figure 1.4  The bottom image shows the foot bones of a medieval person with leprosy buried in the Danish leprosarium cemetery at Naestved; note the highlighted area, which shows that the metatarsals have become very ‘thin’. The top image shows the normal foot bones for comparison.

of the fingers and toes can occur, affecting both normal function and the integrity of the bones of the hands and feet. This damage may lead to impairment and even necessitate amputation of limbs. In a region where leprosy is commonly seen, people with obvious damage to the bones of their face and limbs may be ostracised from their communities. This is notwithstanding the obvious soft tissue changes and damage associated with leprosy, beyond the skin lesions already described. It is, for example, well known that the leprosy bacteria can affect the eyes and the nerves serving the eyelids, which can result in blindness. In addition, facial nerve paralysis may occur, changing the facial appearance. Indeed, the basic functions of all five main senses of the body may be involved in leprosy (sight, touch, smell, taste and hearing). While the senses of the person affected are damaged by this infection, the impact on the senses of communities should also not be forgotten. It may be argued that communities were exposed to

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the odour of people with leprosy who had ulcerated hands, feet and lower legs. They would also have seen the accompanying skin lesions and damaged hands, feet and face, and they may have heard the hoarse voice that results when the larynx is affected. The community may have as a result refrained from touching people with leprosy, perhaps related to a lack of understanding of the disease and how it was transmitted and affected people. Nevertheless, by about 1300 CE in Europe leprosy infection was linked to the air: ‘leprosi infect the air, and this infected air infects in turn when it is drawn in and enters the bodies of people who converse with them. Because the air infects those people, leprosi must be separated from the conversation of healthy people; therefore, let them be forced to live in remote places’ (Breviarium practice).25 This alteration in thinking formed part of a wider shift towards understanding disease transmission in terms of miasma, and was a turning point in how leprosy was understood. In 1363, following the Black Death, Guy de Chauliac made a further, emphatic connection between infected air and leprosy, which reinforced such thinking.26 While attitudes to these ideas changed the focus away from touch, the association with transmission through smell remained, since foul-​smelling air was especially linked to the spread of disease. It should be noted that other diseases may cause all the individual bone changes in leprosy observed by palaeopathologists. However, key to diagnosis is a consideration of the distribution pattern of the bone changes and all the possible diagnoses that might be made (differential diagnosis). Archaeological skeletons can be fragmentary and a specific diagnosis may not be possible to make. The facial bone damage in leprosy may be seen in other infectious diseases, such as venereal syphilis and tuberculosis, and the features in the hand and foot bones manifesting as ‘bent’ fingers and toes could be seen in any disease leading to that sign, for example a stroke leading to paralysis. Many researchers do, however, accept that the full array of features indicating facial bone damage, termed rhinomaxillary syndrome, are specific to leprosy, while the hand and foot bone changes are much more ‘non-​ specific’ in nature. Overall, diagnosis of leprosy in skeletal remains can be very challenging, especially when dealing with fragmentary skeletons, which is often the case with archaeological sites.

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The value of ancient DNA analysis for diagnosing leprosy Some scholars have turned to aDNA analysis to diagnose leprosy, with varying results. The modern leprosy genome was first sequenced in 2001,27 and the ancient genome in 201328  –​ the genome is an organism’s complete set of DNA, including all of its genes. Detecting the aDNA of pathogens to diagnose disease was first used in the early 1990s, whereby bone samples from skeletons with clear evidence of infectious disease (leprosy and tuberculosis) were analysed, and diagnoses were confirmed. It should be noted that one flaw in the interpretation of pathogen aDNA data in several studies has been the assumption that because there is a positive aDNA result, a specific disease has caused the bone damage identified. Unfortunately a direct association cannot be proved! However, this analytical tool has in more recent years enabled scholars to generate data on the strains of the leprosy bacterium affecting people in the past,29 work which has benefited from the sequencing of the modern genome of leprosy. While looking at strains of the bacterium helps us to explore leprosy’s origin and evolution,30 the success of this analysis depends on the extent of preservation of the aDNA in a skeleton, and on correct protocols being used for extraction and interpretation. In addition, aDNA extraction is a destructive process. In the ‘real’ world most palaeopathologists do not use this method for diagnosis (cost can be an issue), and one can question in some studies why aDNA analysis was even used when it was already perfectly clear that the skeleton showed signs of leprosy. However, on a more positive note, aDNA analysis enables scholars (a) to diagnose leprosy when there are no bone changes present even though the context (e.g. a leprosarium cemetery) suggests that the person may have had leprosy; (b)  to explore the evolution of strains of the bacterium (specific to geographic locations); (c) to detect carriers who were not necessarily experiencing leprosy at the time of their death; and (d) to consider the presence of susceptibility and resistance genes. Indeed, there has been a fair amount of aDNA work on skeletons with leprosy, and the most important work has concentrated on identifying the strains affecting these once living people, thus contributing to an understanding of how the infection ‘moved around’ with its human hosts.31

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Now that the bone changes of leprosy have been described and explained, what is the evidence for leprosy in skeletons around the world, and more particularly in medieval Europe; what is the quality of that evidence; and, most importantly, what do the data tell us about the identities of these people, in concert with the wider context or archaeological evidence that tells us about their lives?

Skeletal evidence of leprosy: what does the evidence tell us about community attitudes to people with leprosy in the medieval period? First, it should be noted that it is not only evidence for disease that bioarchaeologists collect from skeletal remains: they also estimate age at death and the sex of the skeleton. This is alongside recording measurements, such as those of the skull, that can inform us about the person’s ancestry or affiliation to a specific geographic region, and also ‘non-​metric’ traits, some of which can be specific to a region of the world. In addition, stature can be estimated, and chemical (isotope) analysis can provide extra data about the person’s diet and mobility during life.32 Thus, inherent biological characteristics may be gleaned from the skeleton, which can be integrated with the evidence for disease in order to appreciate the impact of diseases such as leprosy on specific ancestral, age and sex groups. Additional to biological data for interpretation, bioarchaeologists, by necessity, use the repertoire of other excavated archaeological data, and historical information, as appropriate, to understand the reasons behind the patterns of disease that they observe.

Diagnosis Diagnosis of leprosy relies on the ability of palaeopathologists to diagnose the disease correctly in the skeleton, bearing in mind that the bone changes can be mistaken for other diseases. The quality and quantity of the global data on health derived from palaeopathology are determined by the intensity of work in different parts of the world, and its publication.33 Of course, the quality of the evidence also reflects how well bioarchaeologists have been trained, and this can vary considerably. Furthermore, it should be noted that only 3–​5

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per cent of people with untreated leprosy will potentially develop leprous bone changes,34 and a person’s immune system strength –​ i.e. resistance to the bacterium – w ​ ill affect whether they develop the bone changes, and which ‘type’ of leprosy they will experience (high-​or low-​resistance). Indeed, it is believed that most people whose skeletons display bone changes in archaeological contexts were probably affected by low-​resistance (lepromatous) leprosy. Thus, in palaeopathology only the ‘tip of the leprosy iceberg’ is seen, but potentially more realistic frequency rates for leprosy in the past could be acquired through aDNA analysis. However, screening large numbers of skeletons for leprosy aDNA would be costly, and in any case the aDNA may not have survived burial, thus compromising this aspiration.

Leprosy and identity In thinking about the identities of people with leprosy in the past, it is necessary to consider how those people viewed themselves, and how their communities regarded them. Some of this has been discussed already above. How did people with leprosy feel, physically and mentally, about experiencing the effects of the infection? Was this determined by how their communities regarded the disease? Was it viewed as a disease per se? In turn, community perceptions of, and attitudes to, those affected were probably intertwined with the self-​ identities of people with leprosy, not forgetting that perceptions and attitudes would probably vary depending on how common leprosy was for the region and time period, and that this could change over time. It should also not be forgotten that each person with leprosy and each community in which they lived cannot be attributed a particular ‘standard behaviour’.35 It is difficult, if not impossible, to answer some of these questions, but by taking a broad-​brush approach and using different forms of evidence for leprosy, one can begin to reconstruct an identity for people with leprosy in the past.

The palaeopathological evidence alongside funerary context What is the palaeopathological evidence to date? Data on skeletons with leprosy have recently been synthesised, from a global

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perspective.36 It should be noted that although we know that young people (children) can be affected today, and increasingly so, and there are some historical illustrations and descriptions showing that children and adolescents did contract leprosy in the past,37 there are very few non-​adult skeletons that have been diagnosed with leprosy in archaeological contexts.38 As for a family harbouring leprosy in several of its members, to the author’s knowledge there is no bioarchaeological evidence, at least. The details of the aforesaid synthesis cannot be provided here, as it is somewhat complex and there is a plethora of data, but a summary follows. There is evidence of leprosy in skeletons from four continents (Africa, Asia, Europe and Oceania), and it is particularly common in Europe, where most countries have evidence. However, the data in the Old World is biased towards northern European countries, with less evidence from the Mediterranean and elsewhere. Most evidence comes from Denmark, Hungary, Sweden and the United Kingdom. While northern Europe has the most bioarchaeological evidence, with none confirmed in the Americas, there is documentary evidence in the nineteenth century for leprosy in North America, affecting immigrants,39 and earlier in South America when the Portuguese ‘arrived’ in the fifteenth century.40 Some of the global evidence from archaeology is earlier than historical data for leprosy. The earliest palaeopathological data is from Hungary and dated to 3700–​3600 BCE, with evidence in India, Pakistan and Turkey around 4,000 years old, but most burials with evidence of leprosy date to the late medieval period in Europe (twelfth–​sixteenth centuries CE), and come from urban sites. This is perhaps not surprising considering that towns and cities developed during this period; population density and numbers grew; there was more trade and contact, alongside mobility, as trade networks developed; and poverty increased. Urban contexts are the places also where most archaeological excavation takes place because of new development/buildings. However, this does not mean that prior to this period, when people lived a more rural existence, leprosy was not evident in those communities; it is just that it does not seem to have been as prevalent as later in time in urban areas. Males and females of all adult ages, and a few skeletons of people who had not reached adulthood, have been diagnosed with leprosy. This does not corroborate the clinical data described above (more

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men affected, and peaks of frequency at 10–​14 years old and 30 years and above) but, as also discussed, the extant data do not allow us to generate a real frequency for leprosy in the past. It should also be said that there is extremely little evidence for post-​medieval skeletons with leprosy (1550–​1850 CE), supporting the fourteenth-​century decline for leprosy that has been suggested based on a number of possibilities, including a decline in leprosarium foundations, climate change and an increase in tuberculosis.41 It is, however, surprising to see that, contrary to nineteenth-​and twentieth-​century historical accounts, where medieval leprosy is described as being common, within the medieval period there is also a relative scarcity of leprosy in the palaeopathological record. If a focus is now placed on this medieval period in Europe, where most evidence lies, it is instructive to consider what the data tell us about perceptions of leprosy in communities in which people with leprosy resided, and how people at the time of their deaths were treated. On the one hand, one could argue that if nineteenth-​and twentieth-​ century historical studies are correct and leprosy was extremely common in medieval Europe, then the infection (or ailment) may have been regarded as a part of everyday life. If a person did not have leprosy then they may have been unusual within their community. However, if leprosy was less common than these sources suggest, and as the skeletal evidence indicates, it might be expected that people with leprosy were more likely to be treated differently. Notwithstanding these two potential viewpoints, it is clear from the skeletal evidence that the vast majority of people with leprosy buried in the medieval period were treated in death as ‘normal’ community members, meaning that they were buried normally for the time and place and not, for example, placed on the margins of the graveyard. It is possible to observe this because skeletons with signs of leprosy have been archaeologically excavated from contexts that were provided for the general community at death, as well as from leprosarium cemeteries. In some cases, furthermore, they were clearly considered worthy of a special, privileged burial. It is not the purpose here to document all the late medieval burials showing leprosy, alongside their funerary context, because this documentation is published in full elsewhere.42 Instead, a few examples of the trend described above are provided here from England.

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Four skeletons with evident leprosy were excavated from the monastic cemetery called Blackfriars, on School Street, Ipswich, in Suffolk. They were all buried in the nave or south aisle of this friary church, suggesting higher status.43 These higher-​status persons with leprosy were thus not buried within a leprosarium; similarly, King Baldwin IV (1161–​85), who ruled the Latin Kingdom of Jerusalem and developed leprosy in childhood, was not segregated into a leprosy hospital. As Piers Mitchell states, Baldwin was ‘one of the more remarkable kings in the medieval Christian world … renowned because he developed leprosy and still maintained his position on the throne, becoming a successful ruler’.44 In some places in the medieval period, even though (historically) leprosaria are known to have existed,45 excavations of parish church cemeteries have also revealed burials of people with leprosy. In one particular case (York), three excavated non-​ leprosarium cemetery sites located in one area of the city revealed six skeletons with leprosy, while it is known that there were six leprosaria established around the city between the twelfth and fourteenth centuries. What does this type of evidence say about the treatment of those with leprosy? Perhaps it can be used to suggest that people were more accepted by their communities than has been thought and that, for a range of reasons, not all people with leprosy entered leprosaria and died within these institutions.

The evidence and its relationship to leprosaria Of course, it is well known that while leprosaria were founded to admit people diagnosed with leprosy, these foundations reflected the ‘spiritual aspirations of patrons and benefactors … rather than the actual incidence of leprosy’.46 Best known among the leprosarium cemeteries excavated in Europe are those of Naestved, Denmark47 and Chichester, England.48 However, evidence from the cemeteries of leprosaria provokes questions about the accuracy of diagnosis in the medieval period, since skeletons have been uncovered at these sites that show no leprosy-​related bone changes. While diagnostic methods based on the observation of skin lesions, facial features, urine, blood and sensation loss are mentioned in medieval historical data,49 methods that could be questioned on a

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number of counts, it is very clear that skeletons without evidence of leprosy are buried in medieval leprosarium cemeteries. Why might this be so? It could be that leprosy was diagnosed incorrectly, that some had the high-​resistance form of the infection and did not develop bone changes, or that they may have been diagnosed correctly but had not developed bone changes by the time they died. Two final interpretations could be that they had other diseases that were misdiagnosed for leprosy (e.g., from the end of the fifteenth century, syphilis, as well as many other skin diseases), or even that the person could have ‘faked’ having leprosy in order to be diagnosed and thus receive charity at the leprosarium. Overall, it is clear that burial arrangements regarding leprosy were fluid, both in terms of who was buried within leprosarium cemeteries,50 and in terms of the burial of people with leprosy, who could be buried in contexts that were not associated with leprosaria, such as the cemeteries of parish churches and urban monastic houses.

Conclusions: leprosy and identity from a bioarchaeological perspective This chapter has argued that the vast majority of late medieval (twelfth–​sixteenth centuries CE) people in Europe with evidence of leprosy in their skeletons and in various funerary contexts were more accepted by their communities than has been suggested previously. This argument is based on the bioarchaeological record for burials of people who had leprosy. However, the chapter has not suggested that every person who had leprosy in medieval Europe was welcomed with ‘open arms’ by their communities, because the primary evidence considered  –​skeletons with leprosy  –​does not shed light on how people were treated in relation to every aspect of their lives. Indeed, the archaeological record is incomplete by its very nature. Furthermore, the majority of excavations in more recent decades have occurred in advance of modern developments, such as construction works, and in urban contexts. Thus, the record is biased from a number of perspectives, not least that it is mainly late medieval urban skeletons that have revealed leprosy, rural cemeteries less frequently being excavated. If more rural cemeteries

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were excavated then we might find more evidence of leprosy, and the picture might change in the future. However, skeletons may or may not be encountered in these excavations, and they may be well preserved and suitable for detailed study, or very incomplete. Therefore, it is not surprising that the record of leprosy in skeletons is a fragmentary picture, even in places such as the United Kingdom where archaeological excavations are plentiful. Further, once the data are considered, it can be very challenging indeed to explore the many facets of identity in those people who experienced leprosy.51 To help in this endeavour archaeological data that provide information about the ways in which people with leprosy were buried is helpful. That people with leprosy were mainly buried normally during the medieval period in Europe, as illustrated by the extant evidence, matches well with more recent re-evaluations of historical data that suggest leprosy was not the stigmatising disease that much historical writing of the nineteenth and twentieth centuries suggests. Generally speaking, people with leprosy were not isolated in death and buried ‘out of sight and out of mind’, or laid to rest in a different manner in their graves. In fact, some people’s burial contexts indicate that they held high status, and that significant respect and care were accorded to their bodies. This is not to say that the picture portrayed here will not change in the future:  as archaeology as a discipline marches onwards across the globe, new finds will undoubtedly add to the study and history of leprosy. Nonetheless, it is hoped that re-​evaluating people’s experiences of leprosy in the past through the lens of palaeopathology may in some way help to improve the experiences of people with leprosy today. To know that the archaeological record shows that people were more accepted by their communities, at least in death, may help to change opinions within communities that do not welcome people with leprosy, and may hopefully give comfort to people affected. Finally, it is also hoped that reflecting on, and refraining from using, the stigmatising word ‘leper’ in any context will also be considered by scholars, the public and the media alike in the future –​a linguistic sensitivity that has been promoted since the late 1940s by people working with those affected by leprosy today.52

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Notes 1 D. S. Ridley and W. H. Jopling, ‘Classification of leprosy according to immunity: A five-​group system’, International Journal of Leprosy, 34 (1966), 255–​73. 2 www.who.int/​mediacentre/​factsheets/​fs101/​en/​ (accessed 9 September 2017). 3 See C. A. Roberts, Leprosy: Past and Present (Gainesville: University Press of Florida, 2020); C. A. Roberts, ‘The antiquity of leprosy in Britain: The skeletal evidence’, in C. A. Roberts, M. E. Lewis and K. Manchester (eds), The Past and Present of Leprosy:  Archaeological, Historical, Palaeopathological and Clinical Approaches (Oxford:  Archaeopress, 2002), pp. 213–​ 22; Rawcliffe, Leprosy; Demaitre, Leprosy. On nineteenth-​ century perspectives on medieval leprosy, see also K. Vongsathorn and M. Vollset, Chapter 12 in this volume. 4 R. De Groot, W. H. Van Brakel and H. J. De Vries, ‘Social implications of leprosy in the Netherlands: Stigma among ex-​leprosy patients in a non-​endemic setting’, Leprosy Review, 82 (2011), 168–​77; N. Roosta, D. S. Black and T. H. Rea, ‘A comparison of stigma among patients with leprosy in rural Tanzania and urban United States:  A role for public health in dermatology’, International Journal of Dermatology, 52 (2013), 432–​40. 5 See H. G. Koenig, D. King and V. B. Carson, Handbook of Religion and Health (Oxford: Oxford University Press, 2012). 6 See S. Zakrzewski, ‘Population variation, migration, variation, and identity’, in S. Agarwal and B. A. Glencross (eds), Social Bioarchaeology, Blackwell Studies in Global Archaeology (Chichester: Wiley-​Blackwell, 2011), pp. 183–​211; J. E. Buikstra and R. E. Scott, ‘Key concepts in identity studies’, in K. J. Knudson and C.  M. Stojanowski (eds), Bioarchaeology and Identity in the Americas (Gainesville: University Press of Florida, 2009), pp. 24–​55. 7 C. A.  Roberts, ‘The bioarchaeology of leprosy and tuberculosis:  A comparative study of perceptions, stigma, diagnosis, and treatment’, in Agarwal and Glencross, Social Bioarchaeology, pp. 252–​81. 8 Buikstra and Scott, ‘Key concepts’, p. 26. 9 World Health Organization, ‘Global leprosy update, 2015:  Time for action, accountability and inclusion’, Weekly Epidemiological Record, 91(35) (2016), 405–​20. 10 A. Morrison, ‘A woman with leprosy is in double jeopardy’, Leprosy Review, 71 (2000), 128–​43.

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11 S. Thilakavathi, P. Manickam and S. M. Mehendale, ‘Awareness, social acceptance and community views on leprosy and its relevance for leprosy control, Tamil Nadu’, Indian Journal of Leprosy, 84 (2012), 233–​40. 12 S. J. Yawalkar, Leprosy for Medical Practitioners and Paramedical Workers, 8th edn (Basel: Novartis Foundation, 2009), pp. 22–​3. 13 P. S. Rao and A. S. John, ‘Nutritional status of leprosy patients in India’, Indian Journal of Leprosy, 84 (2012), 17–​22. 14 E. Max and D. S. Shepard, ‘Productivity loss due to deformity from leprosy in India’, International Journal of Leprosy, 57 (1989), 476–​82. 15 W. H. Van Brakel and A. M. Anderson, ‘Impairment and disability in leprosy: In search of the missing link’, Indian Journal of Leprosy, 69 (1997), 361–​76. 16 D. M. Scollard, L. B. Adams, T. P. Gillis, J. L. Krahenbuhl, R. W. Truman and D. L. Williams, ‘The continuing challenge of leprosy’, Clinical Microbiology Reviews, 19 (2006), 338–​81. 17 For analysis of bioarchaeological material from a leprosarium cemetery, see S. Roffey, Chapter 5 in this volume. 18 See for example P. D. Mitchell, ‘An evaluation of the leprosy of King Baldwin IV of Jerusalem in the context of the mediaeval world’, Appendix in B. Hamilton, The Leper King and His Heirs:  Baldwin IV and the Crusader Kingdom of Jerusalem (Cambridge: Cambridge University Press, 2000), pp. 245–​ 58 (on historical data); Roberts, ‘The antiquity of leprosy’; D. Walker, ‘The treatment of leprosy in 19th-​century London:  C case study from St Marylebone cemetery’, International Journal of Osteoarchaeology, 19 (2009), 364–​74; D. A. Lunt, ‘The first evidence for leprosy in early mediaeval Scotland: Two individuals from cemeteries in St Andrews, Fife, Scotland, with evidence for normal burial treatment’, International Journal of Osteoarchaeology, 23 (2013), 310–​18; B. Baker and K. L. Bolhofner, ‘Biological and social implications of a medieval burial from Cyprus for understanding leprosy in the past’, International Journal of Paleopathology, 4 (2014), 17–​24 (all these consider skeletal evidence for leprosy within its funerary context). 19 C. Roberts and K. Manchester, The Archaeology of Disease, 3rd edn (Stroud: Sutton, 2005). 20 See for example R. Porter, Blood and Guts: A Short History of Medicine (London: Penguin, 2002); R. Barnett, The Sick Rose; or, Disease and the Art of Medical Illustration (London: Thames & Hudson, 2014). On medieval artistic depictions of leprosy sufferers, see L. Demaitre, Chapter 8 in this volume.

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21 On such limitations, see, for example, J. W. Wood, G. R. Milner, H. C. Harpending and K. M. Weiss, ‘The osteological paradox: Problems of inferring health from skeletal samples’, Current Anthropology, 33 (1992), 343–​70; P. D. Mitchell, ‘Retrospective diagnosis, and the use of historical texts for investigating disease in the past’, International Journal of Paleopathology, 1 (2011), 81–​8. 22 V. Møller-​Christensen, Bone Changes in Leprosy (Copenhagen: Munksgaard, 1961); Roberts and Manchester, Archaeology of Disease, pp. 195–​8; Roberts, Leprosy: Past and Present. 23 See for example J. Andersen and K. Manchester, ‘The rhinomaxillary syndrome in leprosy:  A clinical, radiological and palaeopathological study’, International Journal of Osteoarchaeology, 2 (1992), 121–​9. 24 V. M. J. Matos, ‘Odiagnóstico retrospective da lepra: Complimentaridade clínica e paleopatológica no arquivo médico do Hospital-​ Colónia Rovisco Pais (século XX, Tocha, Portugal) e na colecção de esqueletos da leprosaria medieval de St Jørgen’s (Odense, Dinamarca)’, Ph.D. dissertation (University of Coimbra, 2009). 25 Demaitre, Leprosy, p. 139 (quoting from the Breviarium practice). 26 Ibid., p. 140. 27 S. T. Cole, K. Eiglmeier, J. Parkhill et al., ‘Massive gene decay in leprosy bacillus’, Nature, 409 (2001), 1007–​11. 28 V. J. Schuenemann, P. Singh, T. A. Mendum et  al., ‘Genome-​wide comparison of medieval and modern Mycobacterium leprae’, Science, 341 (2013), 179–​83. 29 See for example G. M. Taylor, S. Blau, S. Mays et al., ‘Mycobacterium leprae genotype amplified from an archaeological case of lepromatous leprosy in Central Asia’, Journal of Archaeological Science, 36 (2009), 2408–​14. 30 See for example M. Monot, N. Honoré, T. Garnier et al., ‘On the origin 2; M. Monot, N. Honoré, of leprosy’, Science, 308 (2005), 1040–​ T. Garnier et al., ‘Comparative genomic and phylogeographic analysis of Mycobacterium leprae’, Nature Genetics, 41 (2009), 1282–​9. 31 See for example C. Economou, A. Kjellstrom, K. Lidén and I. Panagopoulos, ‘Ancient-​DNA reveals an Asian type of Mycobacterium leprae in medieval Scandivania’, Journal of Archaeological Science, 40 (2013), 465–​70. 32 C. A. Roberts, Human Remains in Archaeology:  A Handbook (York:  Council for British Archaeology, 2018). For documentary evidence regarding diet and leprosy, see E. Brenner, Chapter 6 in this volume. 33 C. A. Roberts and J.  E. Buikstra, ‘Conclusions’, in J. E. Buikstra and C.  A. Roberts (eds), The Global History of Paleopathology:  Pioneers 77 and Prospects (Oxford:  Oxford University Press, 2012), pp.  765–​ (p. 767).

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34 D. E. Paterson, ‘Bone changes of leprosy:  Their incidence, progress, prevention and arrest’, International Journal of Leprosy, 29 (1961), 393–​422. 35 For a detailed study of a medieval person with leprosy, see C. A. Roberts, ‘Applying the “index of care” to a person who suffered leprosy in late medieval England’, in L. Tilley and A. Schrenk (eds), New Developments in the Bioarchaeology of Care:  Further Case Studies and Expanded Theory (Cham: Springer, 2017), pp. 101–​24. 36 Roberts, Leprosy: Past and Present. 37 One of the best-​known historical examples is King Baldwin IV of Jerusalem, discussed below. 38 In Chapter 5 of this volume (p. 149) Roffey documents the burial of a young female child at the leprosarium at Winchester, England, but this was part of a group of burials where only one skeleton had evidence for leprosy, and this evidence was itself uncertain. 39 W. L. Aycock, ‘Familial susceptibility as a factor in the propagation of leprosy in North America’, International Journal of Leprosy, 8 (1940), 137–​50; J. T. de las Aguas, ‘Consideraciones histórico-​epidemiológicas de la lepra en América’, Medicina cutánea ibero-​latino-​americana, 34 (2006), 179–​94. 40 De las Aguas, ‘Consideraciones’. 41 K. Manchester, ‘Tuberculosis and leprosy in antiquity’, Medical History, 28 (1984), 162–​73; A. C. Stone, A. K. Wilbur, J. E. Buikstra and C. A. Roberts, ‘Tuberculosis and leprosy in perspective’, Yearbook of Physical Anthropology, 52 (2009), 66–​94. 42 Roberts, Leprosy: Past and Present. 43 S. A. Mays, ‘The Medieval Burials from the Blackfriars Friary, School Street, Ipswich, Suffolk’ (English Heritage, unpublished Ancient Monuments Laboratory Report 16/​91, 1991). 44 Mitchell, ‘An evaluation’, p. 245. 45 J. Y. Simpson, ‘Antiquarian notices of leprosy and leper hospitals in Scotland and England Part 1’, Edinburgh Medical and Surgical Journal, 56 (1841), 301–​30; R. M. Clay, The Mediaeval Hospitals of England (London: Methuen, 1909); C. A. Roberts, ‘Leprosy and leprosaria in medieval Britain’, Museum of Applied Science Center for Archaeology Journal, 4 (1986), 15–​21. 46 Rawcliffe, Leprosy, p. 5. Also see C. Rawcliffe, Chapter 4 in this volume. 47 V. Møller-​Christensen, ‘Location and excavation of the first Danish leper graveyard from the Middle Ages’, Bulletin of the History of Medicine, 17 (1953), 112–​23. 48 J. R. Magilton, F. Lee and A. Boylston (eds), ‘Lepers Outside the Gate’: Excavations at the Cemetery of the Hospital of St James and St Mary Magdalene, Chichester, 1986–​87 and 1993 (York:  Council for British Archaeology, 2008).

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49 See Rawcliffe, Leprosy, pp. 155–​204. 50 It is also important to consider that the staff and benefactors of a leprosarium could be buried on the site. See E. Brenner, Leprosy and Charity in Medieval Rouen (Woodbridge:  Boydell Press, 2015), pp. 119–​23. 51 Roberts, Leprosy: Past and Present. 52 ‘Leprosy news and notes’, International Journal of Leprosy, 16 (1948),  243–​4.

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Lepers and leprosy: connections between East and West in the Middle Ages François-​Olivier  Touati ‘Leprosy was the dirty residue of the crusades’, according to the nineteenth-​ century French historian Jules Michelet.1 The historiographical time is over when, from a simplistic observation that welfare institutions proliferated in both the West and the East from the twelfth century, one could infer that leprosy was imported to the West through the settlement of the Latins in the Holy Land and, after 1204, in a large part of the Byzantine Empire. Yet this idea is still unfortunately very prevalent and has long clouded the understanding of complex phenomena in medieval societies:  the emergence of leper houses and the question of their models, roles and contexts. The questions at stake relate to the global history of the Middle Ages: travel, routes of communication, contacts between different cultures and religions, and how diseases were spread, especially around one major nexus of communication, the Mediterranean, still readily perceived as the home of civilisation or ‘The Corrupting Sea’.2 When considering one aspect of world history, namely how contacts, exchanges and influences between East and West impacted upon health, other key considerations emerge, such as the circulation of pathogenic agents, standards of living, institutional models and their imitation, and the movement of people and their ideas.3 We may wonder about the nature of diseases: their incidence or prevalence, their hidden or marginal, rare, endemic, pandemic or epidemic character. Research on the permanence or, on the other hand, the variability of the pathogenic vectors of diseases in the past is relatively new. The plague and the demographic devastation brought during its spread on two occasions, from Egypt in 541 and

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from the Black Sea in 1347, have received especial attention.4 Well known, the global scale of these epidemics is obvious. But their matrix led to particular models of the nature of diseases and of how they are transmitted. We should in fact be careful to distinguish the specificity of each disease: the impact of leprosy was less spectacular or sudden than that of the plague, but was nonetheless profound and felt over a very long period of time. As is the case for other pathologies, leprosy merits consideration on its own terms.

The origins of leprosy in East and West Prior to its emergence in Paris, in the fourth century, suddenly illuminated in the light of thaumaturgy through the miraculous kiss given by Saint Martin to an anonymous leper in the crowd,5 leprosy was a disease known since ancient times in the Middle East (Egypt, Phoenicia, possibly Mesopotamia), where the ancient authors place its origin.6 Greek physicians of the fifth-​to-​fourth centuries BCE, particularly those whose works are found in the Hippocratic corpus, used a range of terms that potentially evoke leprosy: lepra, leukè, alphos. The multiple meanings of these terms have been carefully studied by Mirko D.  Grmek:  the vocabulary covers different pathological realities within ‘the circle of skin diseases’, rather than showing ‘real nosological unity’ strictly related to Hansen’s disease. In terms of chronology, it was not until the third century BCE that leprosy, previously an ‘exotic disease, limited to the eastern countries’, came ‘to reach a level of visibility for the medical perception of the Greeks’.7 The terminology finally became fairly settled as elephas or elephantiasis in the second century BCE. Lucretius, who died c. 55 BCE, was the first Roman author to pass on information about leprosy to the West:  for him, elephas morbus, ‘born on the banks of the Nile in central Egypt, is found nowhere else’. However, 100 years later the spread of the disease had increased, and thinking about leprosy had changed. For Pliny the Elder (23–​79 CE), for example: [Elephantiasis] was not sufficiently visible in Italy before the time of Pompeius the Great. The disease usually begins to manifest on the face and nose by a kind of small pustules, and soon the skin becomes dry and the whole body is covered with spots of various colours, streaks,

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thick here, slim there, also hard, or covered with surface roughness as in scabies, and in the end the skin turns black and presses the flesh on the bones, while the fingers swell in the feet and hands. This evil, especially in Egypt, was disastrous for the people when it reached the kings, since the baths in which they were treated were mixed with human blood. In truth, the disease was quickly extinguished in Italy.8

In his prolific work, Pliny did not mention elephantiasis more than eight times. He referred thirty-​one times to what he called lepras, without clearly defining its meaning, but in relation to a host of conditions and remedies.9 This suggests that a new, although sporadic, disease was in the process of being firmly identified, much as the terminology regarding leprosy had become increasingly well defined in Greece three centuries earlier. Indeed, Celsus (25 BCE–​37 CE), writing at about the same time as Pliny, stated that this was ‘a disease almost unknown in Italy but widespread in some countries, that the Greeks called elephantiasis’, before continuing: It belongs to the category of chronic afflictions. The whole body is affected to the point that even the bones are altered. The body surface is dotted with numerous spots and tumours, whose colour is red with a blackish tint. The skin becomes uneven, sometimes thick, thin, hard, soft or flaky … causing a swollen face, legs and feet. When the disease has progressed to a certain point, the toes and hands collapse under the effect of the tumour, mild fever appears.10

At the same time (first century CE), a similar description is provided by the Greek physician Aretaeus of Cappadocia, under the term elephas; the symptoms of the disease are described as elephantiasis by Rufus of Ephesus and Oribasius: ‘livid and dense black on the face, arms, legs, back, chest, stomach, etc. Swollen lips, rotting flesh, falling fingernails, etc. Its origin is as profound as that of cancer’.11 As the leprologist J.  G. Andersen stated in 1969, such clarity ‘leaves no doubt about the identification of low immune resistant (lepromatous) leprosy’.12 In the second century CE, Galen used two sets of terminology: in thirty-​two passages he deployed the word lepra, and he referred thirty-​ one times to elephas, elephantia or elephantiasis. Only this later set of references seems really to match the symptoms of lepromatous leprosy. Galen’s work reported the incidence of the disease in Europe at a new level: after noting the presence of

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leprosy in the north-​east of Asia Minor not far from the Bosphorus (Mysia), the text attests to its manifestation beyond the Alps, as far as Germany.13 In the early centuries CE, the presence of leprosy is also attested (or suggested) in the central region of Gaul, the valleys of the Meuse (Maas) and the Escaut (Scheldt), and finally in the British Isles and Ireland during the sixth century.14 The analysis suggests a settlement ‘pattern’ of leprosy. First, despite the lack of clarity regarding the aetiology of the disease, the near certainty of its identification is correct, at least in its more visible form, lepromatous leprosy.15 Other forms of the disease are, however, less recognisable at this time. While the descriptions of the symptoms primarily concern the appearance of the skin, the ancient authors make no mistake about leprosy’s chronic and progressive nature. The disease was certainly not understood simply to be a skin complaint, which does not however exclude differential comparisons.16 Other authors incorporated the descriptive terms for leprosy described above into their works. These include Scribonius Largus in the first century CE, and Quintus Serenus between the late second century and the early third century, whose writings were collected and collated in the following century by Pliny the Younger and Marcellus Empiricus.17 The works of Pliny and also Lucretius were not strictly medical texts but encyclopedias, accessible to a larger number outside the narrow circle of medical specialists. From the late fourth century, with the Latin translation of the Bible, the word lepra and its derivative leprosus were substituted in most Latin writings for the word elephantiasis. At this time, writers unconnected with the medical community, such as Vegetius, a Roman writer living in Constantinople, or Orosius, a Spanish disciple of Saint Augustine, defined the disease according to criteria similar to those of medical authors.18 Other sources of evidence, such as hagiographic works (e.g. the Books of Miracles of Gregory of Tours), confirm that leprosy was present and identifiable in Europe from at least the fourth century. Iconography, such as the early-​ninth-​century ivory panels of the Andrews Diptych in the Victoria and Albert Museum, London (Figure  2.1), corroborates the identification and correct representation of leprosy sufferers in Europe from the fourth to the ninth centuries.19

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Figure 2.1  The early ninth-century ivory panels of the Andrews Diptych, Victoria and Albert Museum, London (A.47&A-1926). The diptych depicts the six miracles of Christ, with the healing of the leper at bottom right.

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Taking the route from East to West, arriving in Paris, on the road of Saint Martin, the transmission process seems to repeat itself in a similar way:  a few sporadic cases, then a greater sharpness of observation and evidence follows, which indicates a growth of the endemicity. Which factors facilitated transmission? Clearly, for both ‘healthy’ and ‘vulnerable’ populations, the development of trade and other flows of communication played a crucial role in the spread of disease. Other factors included the conditions of the environment (biological, pathological), and socio-​economic variables such as standards of living. These factors influenced the extent to which leprosy took root and developed within a population. The movement of armies has traditionally relied on major routes of communication, and this factor should not be underestimated. The appearance of leprosy was observed following large-​scale transfers of troops from East to West, and in the context of conquests, civil wars and defence against invasion. Examples include the journeys of the Emperor Julian (361–​3) and his troops, or the travels of Saint Martin of Tours. The movement of civilians (merchants, slaves, pilgrims, scholars, evangelists) could also explain the dissemination of the disease. And indeed, the points of major traffic appear punctuated by cases of leprosy; they are also privileged places of assistance for lepers. Leprosy may have been especially visible at these points of traffic because they were sites where charity was distributed. The mixing of populations was intense in Europe at least until the sixth century, and the collapse of the Roman Empire gave way to harsher conditions of life, increasing people’s vulnerability to disease. Under these conditions, the presence of a leper in Paris in the fourth century, kissed by Saint Martin after he had rescued the poor of Amiens, is symbolic, but perhaps also reflective of daily reality.20 We must note that the leper is, however, not separated from the people but in the midst of a crowd, as is the case in many other accounts of the early Middle Ages. Is the dominant impression, until the tenth century, one of a limited increase of the disease? Or, on the basis of provisions such as those from the Council of Orléans in 549, which provided for organised assistance to lepers as a collective group, could we conclude that leprosy had reached the point of being endemic?

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Written in the late sixth century, the Life of Saint Severin reports a similar gesture to that of Saint Martin by Severin when the latter enters Paris. The narrative emphasises the presence of only one leper, coming from Milan, encountered by Severin:  ‘unus erat ibidem leprosus’ (‘there was one leprous man there’). It continues: ‘Multi quidem et  alii infirmi erant in domum regis et sub urbe Parisius’ (‘many other sick people were in the king’s palace and below the city of Paris’).21 This observation implies a greater number and variety of ‘sick’ people in Paris, either protected by the king or wandering as beggars. The leper stood out among them. We should perhaps reconsider the chronology of leprosy in the early Middle Ages. A high occurrence of testimony occurs until the late sixth century, and then is only found again during the tenth century: does that mean that the disease declined before recurring more acutely a few generations later? This possible chronology leads to a hypothesis. After the importation of leprosy to Europe from the East, related to the development of the Imperium Romanum, probably strengthened by increased communication with sufferers in the Lower Empire, the disease came to the forefront in the fourth century, around the time that the leper of Saint Martin is the ‘exceptional’ testimony. Thereafter it reached a first phase, predominantly in the lepromatous form, if we note the insistence of sources on the facial symptoms. This phase would be developed over a few generations, culminating between the late fifth century and the late sixth century. People were very much weakened by precarious conditions of life, suffering the effects of extreme weather events (unusually harsh winters, summer droughts, intermediate torrential rain) and periods of rare but severe famine, all exacerbated by the changes and economic ravages caused by war. This made them vulnerable to disease. The plague from the East in 541 touched the north-​east of Europe, and the last testimony was in Italy in 767. Dysentery, malaria, smallpox and influenza  –​and perhaps phthisis, or tuberculosis –​were emerging at the same time, even if their respective impacts remain insufficiently known. The survivors, who were biologically selected, might present a stronger immune resistance. It is possible that the number of lepers declined as a result of this pathocenosis, unless the predominant forms of the disease, reversing the trend, had shifted towards the tuberculoid or indeterminate type, adapted to a higher resistance.

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Descriptions of leprosy in encyclopedic works of this period are telling. The Etymologies of Isidorus of Seville (570–​ 636) devotes only two short sections to leprosy (lepra associated with elephanticus morbus), and presents the disease as an almost abstract entity, with only brief consideration of its symptoms, by noting the skin changes that affect the body as being rough, and black, white or red.22 The revision of this work and new developments by Rhabanus Maurus (c. 776–​856) in his extensive encyclopedia (De rerum naturis sive de Physica sive de Universo), despite slipping into an allegorical association of leprosy with heresy, presented a much fuller treatment of leprosy, considering the variety of forms of the disease and the range of symptoms. Rhabanus discerned no fewer than ten manifestations (in cute, in barba, in corpore toto, tumens, humilis, inflata, rubens, alba, in carne viva, volatica).23 These characteristics of the disease were clearly distinct from scabies or impetigo, among other conditions. Was Rhabanus’s specificity the result of his direct observation of leprosy in the West (at Tours, or at Fulda), or in the Holy Land, where he seems to have gone between 807 and 814 and where he participated in the drafting of the Memorandum de Casis Dei requested by Charlemagne? Among the religious establishments surveyed in the Memorandum, the examples of lepers living with monastic communities, such as the Armenian house of Saint Stephen in Jerusalem, which then hosted fifteen lepers, offered a model for living and a vision of the disease in all its aspects.24

Early leprosy hospitals: a model in the East? Leaving aside the question of the ancient sāra’ath (the Hebrew word for leprosy), but without forgetting the lepers of the Gospels, osteological traces of leprosy dating from the fourth century have been excavated in the Judaean Desert (Byzantine monastery of Martillous), near the River Jordan (monastery of Saint John the Baptist), and in Egypt (El-​Bigha) in the sixth century.25 South-​east of Jerusalem, Deir Dosi, the monastery founded by Saint Theodosius the Cenobiarch (424–​529), a native of Caesarea in Cappadocia, had a complex of multiple hospitals for each ‘nation’ (Greeks, Georgians, Armenians and Bessi, a tribe from Thracia) –​this fact

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attests to the movement and mixing of populations. Deir Dosi also had another care facility, which is described by Theodore of Petra in the early sixth century as intended, in his words, ‘for the lepers crucified in the world for Christ’.26 At the same time, Nona, bishop of Edessa, installed a leper hospital at the Well of Job (Bir Eyüp), famous for its thermal properties.27 The prototype of these foundations was based on the will of Saint Basil (330–​79), who wished to ‘cherish the bodies which precede the downfall of ours’ (Ascetic Constitutions). Saint Basil installed, around 370, in Caesarea, a huge monastic complex complete with hospitals and clinics, as well as a house for lepers. Similarly, the Life of Saint John Chrysostom (344–​407), written in about 408, marks the project in Constantinople of building an asylum for wandering lepers. These prototypes are well known.28 Through the simultaneity of these foundations, then, can we recognise an increased prevalence of the disease in the East between the fourth and sixth centuries? The possibility of ‘infectious outbreaks’ of leprosy in this part of the world has been raised by a study of the first leper colony in Constantinople, the hospital of Saint Zôtikos. Its tales of legendary foundation only date from the eleventh century, in the Life of Saint Zôticos written under the basileus Michael IV Paphlagonian (1034–​41). This hagiography refers to the Constantinople of Constantine I  (306–​37) and his second son, Constantius II (337–​61).29 A decree of Constantine I ‘in reference to the law of origin’ (Leviticus?) required the expulsion of the lepers from Constantinople, and for them to be drowned in the sea. The magistrianos (imperial official) Zôticos opposed this order. He installed the lepers on the hill Eleônes (of the ‘olives’), where the feast of the Ascension was being celebrated, in Galata, beyond the Golden Horn, and even accommodated the leprous daughter of the  emperor there. Was this expulsion motivated by ‘fear of contamination’?30 The neighbourhood, near a burial area, above Sykai, quickly became very crowded. After the emperor Constantius visited this establishment, he tortured Zôticos, but miracles were accomplished. Constantius, having finally repented, had a hospital for lepers built there. Directly inspired by the terminology of Saint Basil, the lepers of Saint Zôticos’s hospital were ‘brothers of Saint Zôticos [adelphon ton hogion Zoticon]’, as stated on the seal of the institution.31

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Another leper colony at Constantinople, dependent on Saint Paul’s Orphanage, was founded by Justinian (527–​ 65). It was rebuilt after its destruction in 624 by the Avars. Justinian also restored a leper house in Argyrônion (Saint-​Pantéléèmon, today Yusa Tepesi, on the eastern shore of the Bosphorus). Constantine VII Porphyrogenitus (913–​59) expanded it, showing his devotion to the elders and ‘lepers’. According to Theophanes Continuatus, Constantine VII was a caregiver to the leprous, as was Michael IV Paphlagonian (1034–​41), who himself was probably the sponsor of the Life of Saint Zôticos. Michael Psellos (1018–​ 78), in his Chronography, described Michael IV’s compassionate attitude: As usual, people avoid attending those whose bodies were covered with sores [dialélôbèménon ta somata]. It was something surprisingly beautiful to see [the emperor] attending them, putting his face on their sores, and then kissing them, pressing them against his heart, caring for them with baths, serving them as does a servant his masters.32

The Life of Saint Zôticos even adds, describing Michael IV, ‘Purifying their pus and their sores with baths, their bodies devoured by this cruel disease, in fact in imitation of Christ, our pious Emperor, after entering the bath, pours hot water to wash our brothers in God, and he sometimes cleans their feet like a slave, kisses them and takes them back to their beds.’33 As well as being paralleled by the actions of western saints such as Martin of Tours and Francis of Assisi, might Michael IV’s own affliction –​epilepsy –​have led to this quasi-​hagiographic depiction of him as carer for the weak? Such gestures by Michael IV were echoed in other scenes in the East, such as that reported by the physician Ibn Butlan in 1051 in Antioch, where the patriarch was said to bestow the same care upon the leprous.34 A  similar compassion can also be found with John II Comnenus (1118–​43), who created in 1136 the monastery and great hospital of Christ the Saviour Pantocrator, which provided residential care for patients with the ‘sacred disease’ (hiera nosos), probably leprosy.35 Can we infer anything from hospital foundations about the epidemiological nature of leprosy and its evolution? Nothing between the fourth and sixth centuries, contrary to the views of commentators who allege the ‘outbreaks of epidemics’ and even talk of a ‘panic of the authorities’.36 No more so for the eleventh

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and twelfth centuries: the legend of Zôticos, forged in the eleventh century, employs all the features of hagiographical rhetoric, but cannot teach us anything about the prevalence of leprosy at that time, since it is largely based on legends of an earlier hospital foundation, just like that of Saint Lazarus of Jerusalem, which is supposed to date back to the Maccabees.37 Certainly, as determined by Paul Magdalino, Constantinople experienced a high level of immigration in the eleventh century, but can we really deduce an ‘increase’ of its population between 1014 and 1044, then in the years 1077–​80?38 And even if there was demographic growth, would that necessarily have led to an increase in leprosy? A simplistic link, a false correlation: how many times do we have to repeat that the creation of hospitals has very little to do with demographic factors or with health situations in their entirety? Indeed, not all leprosy sufferers entered hospital communities or had their freedom of movement restricted in the Middle Ages.39 In the fourteenth and fifteenth centuries, accounts of miracles (associated with Xanthopoulos, or the Russian deacon Zosimus) show the presence of lepers circulating in perfect freedom in the heart of Constantinople, seeking curative mud and sand mixed with tanks of holy water from the great church of Hagia Sophia.40

Responses to leprosy in the West Attitudes and responses to leprosy in the West reveal processes of imitation, diffusion, emulation and even competition between East and West. The first western leprosaria were established a little later than those in the East. The western foundations are attested by Gregory of Tours (539–​ 94) at Chalon-​ sur-​ Saône (xenodochium leprosorum), Saint-​Claude (hospitiolium leprosorum) and Valais, near Saint-​Maurice.41 Others followed at locations such as Metz (before 625): all were on major axes of passage. Lepers were also greeted and hosted at monasteries, such as Saint Hilaire of Poitiers, or Sainte Croix, where Saint Radegund cared for and cured the sick.42 From the early Middle Ages in the West, hagiography furnishes numerous examples of saints who provided models of attitudes and behaviour towards lepers: Saint Agile, abbot of Rebais, a disciple

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of Saint Columbanus in the seventh century; Saint Fursey (d. 650), abbot of Lagny in Brie; Saint Aderald in Troyes, who returned from the Holy Land in the tenth century; and others.43 These examples testify to the presence of sanctuaries, from the Mediterranean coast to the Loire valley, where lepers came to seek healing. The great monastery of Saint Martin of Tours formed the head of a nexus of routes of traffic for lepers, although some travelled further, to Jerusalem, as depicted by Gregory of Tours.44 Multiple trips by western people to the Holy Land and to Constantinople, a place with which the Venetians and the people of Amalfi ‒ among others ‒ were in close contact, show the importance of trade, exchanges and ‘impressions’ inspired by eastern practices and experiments. In terms of medical influences, around 590, in Poitiers, King Chlotaire I’s physician, Reovalis, successfully practised surgery on a child ‘as he had seen operated at Constantinople’.45 These exchanges, through pilgrimages for example, especially the quest for healing in the footsteps of Christ, multiplied during the tenth and eleventh centuries, just when there was apparently a new increase in attention to lepers in the West. The Life of Saint Athanasius, bishop of Naples (d. 872), whose name and situation were linked with Greece, is the first western text to name lepers ‘lazars’, lazari, after Saint Lazarus, echoing the designation given to them by Basil’s brother, Saint Gregory of Nyssa (d. 394).46 With respect to the Byzantines, it was fashionable on the western side, from Liutprand of Cremona and his famous embassy to Constantinople in 968 onwards, to criticise the culpable negligence of the Greeks with regard to the poor. For example, attention was drawn to the inadequate provision for the poor in the Épanagôgè (the law code promulgated in 886 by Emperor Leo VI), and to the measures undertaken in 964 by Nicephorus Phocas prohibiting any new charitable foundation.47 From the ninth century, theologians and preachers set the tone in the West, even denying the prohibitions of Leviticus, as Haymon d’Auxerre stated, for example: He, who could heal without the need for direct contact, did not refuse to touch the leper that the law ejected out of the camp … showing why his touch is the salvation of those who believe in Him. Why would the Lord touch a leper when the law prohibited Him from doing so? First, to set an example of humility and compassion,

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and not to judge our neighbours as despicable because of any infirmity. Then, to show us that He was not a slave to the law, but rather master of it.48

The meeting of King Robert the Pious with lepers at Easter 1029, reported by the abbot of Saint Benoît-​sur-​Loire, Helgaud of Fleury, fully deserves to be compared with the gesture of the basileus Michael IV Paphlagonian in supporting the writing of the Life of Saint Zôticos. This famous episode of Robert the Pious precedes Michael’s coronation in 1034, but is not without a relationship with the Byzantine Empire, since Oury, bishop of Orleans, returning from Jerusalem, brought to Robert the Pious a fragment of the Holy Cross from the emperor Constantine VIII (970–​1028). When Robert encountered the lepers: The man of God [King Robert] did not turn aside with horror, because he had read in the Scriptures that often Christ our Lord, in his human aspect, had received the hospitality of the leper (Matthew 26:6–​13 and Mark 14:3–​8). He approached them with an eager soul, he came in their home, and with his own hand, gave them a sum of money, and with his own mouth, he printed kisses49 on their hands … Even better, the divine virtue bestowed on this man such a perfect grace to heal the body [in gratiam medendi corporis] that when he touched the sick with his very pious hand and they marked themselves with the sign of the Holy Cross, he delivered them from the pain of their sickness [auferret ab eis dolorem infirmitatis].50

Although often seen as the origin of the royal touch, we note here that there is no question of ‘cure’, but rather that the emphasis is on care, appeasement and the strict application of evangelical charity, the reproductive Christological model being expressly mentioned: relief, compassion, communion, sympatheia, as we see in later scenes imitated or exceeded at Saint Lazarus of Jerusalem in the twelfth century, as an escalation of this phenomenon. Such behaviour is also described by Gerard of Nazareth, who was a hermit of Mount Carmel before becoming bishop of Latakia between 1139 and 1161. His testimony provides some striking portraits of the conversion of the Franks in the service of lepers, as in the case of a certain Aubry: ‘He eats the food left by the lepers, kisses each of them after daily Mass, washes their feet, cleans and makes their beds, bears on his shoulders the weakest among them

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to their beds.’ Gerard continued, almost embarrassed ‒ horribile dictu ‒ to depict the scene: One day, after washing the feet of a leper, water mixed with blood and pus gave him nausea; Aubry immediately plunged his whole face in it! His personal cell seemed more a prison than the chamber in which he chose to live freely. He frequently inflicted discipline upon himself, to the point of bleeding. Murmuring prayers, he lay on the dirt or on his knees, to the point of bringing about calluses. He contented himself with barley bread and water, wore a very harsh hair shirt and walked barefoot. His tonsure and unevenly shaven beard made him look like a buffoon, and when secular clerics approached him he frightened them through sharp jokes of bad taste, or he despised them with a hypocritical arrogance.51

Gerard’s account reflects the twelfth-​century height of the religious fervour regarding leprosy that had gradually grown since the eleventh century, and had been reinforced through the foundation of leper houses, as soon as sufficient material means allowed autonomous communities of lepers to develop. Lepers were seen as ‘pre-​sanctified’ and ‘pre-​sanctifying’, and the increase in institutions in the West from the eleventh century echoed the focus in the East on the holy status of lepers and the need for compassion towards them. Baldric of Bourgueil, chronicler of the First Crusade, wrote: The Scriptures teach us that the Lord disciplines those He chooses, flagellating the son whom He brings to Him (Hebrews 12:6), thus preparing the kingdom of heaven for those he disciplines. The reason and humility of the human condition persuade us to bring relief to the lepers still far from the camp, equipped with constancy, deprived of the sweet and familiar life with their parents and friends; they bear the pangs of abandonment of worldly affairs in the hope of eternal reward.52

These sentences are directly based on the Epistle to the Hebrews. This capital page of Holy Scripture inspired the main narrators of the First Crusade, from Guibert of Nogent up to Baldric of Bourgueil, who repeated it again in his De visitatione infirmorum and also in the Historia Hierosolomita. The Epistle to the Hebrews confirms the meaning of the implantation outside the camp reserved to lepers: ‘Christ suffered outside the gate in order to sanctify the people with His own blood. Let us go to Him outside the camp

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and bear the reproach He endured [to participate in His sacrifice]’ (Hebrews 13:11–​13). Guibert of Nogent, by commenting on this passage in his Dei gesta per Francos, explained that lepers should attach themselves to the mortification of the Cross, overcoming the impulses of the flesh.53 The continuation of the Epistle to the Hebrews (13:14–​16) summarises the project:  charity and sharing (each part personified by Martha and Mary, the sisters of Lazarus in the Gospels), and the implementation of perpetual praise to God. But were compassionate attitudes to lepers, such as those of Aubry described by Gerard of Nazareth, still exceptional? Was this discourse in fact only a justification ‒ again and again ‒ of ‘exclusion’? The picture is not straightforward. One should rather emphasise the timing, the inspiration shared by the western crusaders with the Greek world, especially the eastern world. At the same time, the movement in the West to assist lepers, and the sick poor more generally, preceded the First Crusade: here it will be sufficient to cite the example of Archbishop Lanfranc (1070–​89), founder of two new hospitals within his city, Canterbury, and of wooden houses for lepers ‒ male and female ‒ to live under the patronage of Saint Nicholas at nearby Harbledown.54 And after that, Lanfranc’s model was duplicated, in England, and perhaps also at Bayeux or Caen in Normandy, France. Yet many western examples could still be cited of the foundation of charitable hospitals as a result of their benefactors’ trips to the East, at Montmorillon in Poitou, for example.55

Conclusion As I have demonstrated elsewhere, in the state of our knowledge, there is nothing to suggest that the successive pathocenosis encountered in the Middle East, mainly in respect of leprosy, was worse than that of western disease patterns:  quite the contrary.56 Our knowledge about leprosy relates primarily to attitudes and responses in both East and West, rather than to the prevalence of the disease. The focus on patients in the East, the importance of health resorts there, and their frequent use by westerners are attested early on: by Gregory of Tours, corroborated by travellers such as Theodosius (after 518) or in the Itinerary of Pilgrimage by

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an anonymous pilgrim of Placentia about 570. The author of the Itinerary reports having seen many lepers return (to Gaul!) from the baths of Elijah in Gedera or those of Moses in Livias (Tell el-​Rame in Jordan near the Dead Sea).57 Leper (al-​mujādhdamīn) Christians were even rescued on the road from the Golan to Damascus in al-​Jâbiya, where Caliph Umar (634–​ 44) gave them ṣadaquāt (alms regularly and permanently assigned). In Damascus itself, in 707, Caliph al-​Walid (705–​15) provided a substantial income for a hospital, with physicians, catering for the infirm, the blind and victims of leprosy.58 It is true that the caliph’s uncle ’Abd al-​’Aziz (d. 704), suffering from the ‘disease of the lion’ (marad al-​asad or dā’ al-​asad), had personal experience of a disease that still did not stop him from governing Egypt for twenty years. This Arabic qualifier is identical to the description of leprosy (‘lion-​ sickness’) by the physician of Cappadocia, Aretaeus: perhaps there was a Greek heritage in the local environment of Damascus? Other charitable foundations  –​in Kairouan, dār al judhamā’, near the hospital of Dimnah, about 830; at Fez in Morocco; or in Cordoba, Munyat ’Adjab, named after a wife of Caliph al-​Hakam I  (796–​ 822) –​reflect the spread of both the disease and of patients around the Mediterranean Sea, as well as how charity was a key feature of Islam.59 More widely, the movement of people along trade and pilgrimage routes between East and West helps us to appreciate how ideas, attitudes and practices relating to lepers and leprosy circulated on a global level. These exchanges are crucial to understanding the development of leper houses, the institutions that supported leprosy sufferers and enabled them to form communities and share in a common identity. Leprosaria did not emerge primarily because of anxieties about contagion, but rather as a result of social and religious currents and complex cultural exchanges.60

Notes 1 J. Michelet, Histoire de France, new edn, Le Moyen Age (Paris:  R.  Laffont, 1981), p.  479, and La sorcière, new edn (Paris:  Garnier-​Flammarion, 1966), p.  106. His words are inherited from the thought of the Enlightenment (Voltaire, W. Black), summarised

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by M. de Choiseul-​Daillecourt in his essay De l’influence des croisades sur l’état des peuples de l’Europe (Paris: Tilliard, 1809). L. A. Labourt, Recherches sur l’origine des ladreries, maladreries et léproseries (Paris: Guillaumin, 1854), and above all G. Kurth, La lèpre en Occident avant les croisades (Paris: Bloud, 1907), were the first to contest this opinion. See Touati, Maladie, pp. 29‒37; and F.-​O. Touati, ‘Contagion and leprosy: Myth, ideas and evolution in medieval minds and societies’, in L. I. Conrad and D. Wujastyk (eds), Contagion: Perspectives from Pre-​Modern Societies (Ashgate: Aldershot, 2000), pp. 161‒83. 2 P. Horden and N. Purcell, The Corrupting Sea: A Study of Mediterranean History (Oxford: Blackwell, 2000). 3 T. S. Miller and J. W. Nesbitt, Walking Corpses: Leprosy in Byzantium and the Medieval West (Ithaca, NY: Cornell University Press, 2014), makes no connection or comparison between East and West, limiting itself to a juxtaposition of the two situations. 4 For plague see, in particular, M. H. Green (ed.), Pandemic Disease in the Medieval World: Rethinking the Black Death (Kalamazoo: Arc Medieval Press, 2015); F.-​ O. Touati, ‘La peste comme modèle’, Sources: travaux historiques, 22 (1990) (special issue on Images de la maladie: La peste dans l’histoire), 6–​8. For leprosy see H. D. Donoghue, G. M. Taylor, A. Marcsik et  al., ‘A migration-​driven model for the historical spread of leprosy in medieval Eastern and Central Europe’, Infection, Genetics and Evolution, 31 (2015), 250–​4. DOI: 10.1016/​ j.meegid.2015.02.001. 5 Sulpicius Severus, Vita sancti Martini, XVIII, ed. J. Fontaine (Paris: Cerf, 1967), Vol. I, p. 292; Touati, Maladie, pp. 85‒93. 6 Lucretius, De rerum natura, VI, vv. 1114‒1118; Pliny the Elder, Historia naturalis, XXVI, 3; Galen, Commentaire au Prorrhétique II, ed. E. Littré, IX, p. 74 n. 7; T. Bardinet, ‘Remarques sur les maladies de la peau, la lèpre, et le châtiment divin dans l’Egypte ancienne’, Revue d’egyptologie, 39 (1988); M. D. Grmek, Les maladies à l’aube de la civilisation occidentale (Paris: Payot, 1983), p. 227. 7 Grmek, Les maladies, pp. 244–​8; K. Manchester, ‘Leprosy: The origin and development of the disease in Antiquity’, in D. Gourevitch (ed.), Maladie et maladies:  Histoire et conceptualisation. Mélanges en hommage à M. D. Grmek (Geneva: Droz, 1992), pp. 31–​49. 8 Pliny the Elder, Historia naturalis, XXVI, 5. 9 References by J. G. Andersen, ‘Studies in the mediaeval diagnosis of leprosy in Denmark’, Danish Medical Bulletin, 16, supplement 9 (1969), 28‒9. 10 Celsus, De arte medicina, III, c. XXV.

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11 Collectio medica, VII, 24 and XLV, 28; Oribasius, in Rufus, Fragments extraits d’Oribase, ed. C. Daremberg (Paris: 1879), p. 305. 12 Andersen, ‘Studies’, 18–​19, 42–​3. 13 Πρòς Γλαύκωνα θεραπευτικόν (Ad Glauconem de medendi methodo), II, 12, ed. C. Daremberg (Paris: 1856), Vol. II, pp. 782‒4. 14 Touati, Maladie, pp. 91‒4; J. Reader, ‘New evidence for the antiquity of leprosy in early Britain’, Journal of Archaeological Science, 1 (1974), 205‒7; C. Wells, ‘A possible case of leprosy from a Saxon cemetery at Beckford’, Medical History, 6 (1962), 383‒6; K. Manchester, ‘A leprous skeleton of the 7th century from Eccles, Kent, and the present evidence of leprosy in early Britain’, Journal of Archaeological Science, 8 (1981), 205–​9; on the presence of leprosy in Winchester from at least the tenth century, see S. Roffey, Chapter  5 in this volume. Leprosy was also present in Scotland, according to the Life of St Kentingern (540–​612), AASS, 13 January, I, p. 818; and in Eire (Finnian’s Penitential 95), ed. L. Bieller, The Irish Penitentials (Dublin:  Dublin (c. 575–​ Institute for Advanced Studies, 1975), p. 84, §29). 15 On the differences between lepromatous and tuberculoid leprosy, see C. Roberts, Chapter 1 in this volume. 16 Touati, Maladie, pp. 91–​6. 17 Compositiones, in Thesaurus linguae latinae (Leipzig:  Teubner, 1973), cols 1177‒8; Quintus Serenus, Liber medicinalis, X, ed. and trans. R. Pépin (Paris: Presses universitaires de France, 1950), p. 13; De medicina, XVIII, ed. V. Rose (Leipzig: Teubner, 1875), p. 33; De medicamentis, ed. G. Helmreich (Leipzig: Teubner 1889), pp. 180‒3. 18 For Vegetius, ‘uligines pedes exulcerant ad similitudinem leprae … color diversus appareat’, in Thesaurus linguae latinae, col. 1177; Orosius, Historiam adversus paganos, IV, 12. 19 Touati, Maladie, pp.  85–​ 96; F.-​ O. Touati, ‘Facies leprosorum: Réflexions sur le diagnostic facial de la lèpre au Moyen Age’, Histoire des sciences médicales, 20 (1986), 57‒66; London, Victoria and Albert Museum, museum no. A.47&A-​1926. 20 For a visual depiction of Saint Martin’s kiss, see Figure 8.14 in Luke Demaitre’s chapter in this volume. 21 Monumenta Germaniae historica, SSRM, III, p. 170, §6. 22 Isidorus of Seville, Etymologies, ed. W. M. Lindsay, Vol. I  (Oxford: Oxford University Press, 1911), pp. 190‒2, Book IV, De medicina, VIII, 11‒12 = Patrologia latina (hereafter PL), 82, cols. 191–​2: ‘Lepra vero asperitas cutis squamosa’. 23 PL, 111, col. 502b. 24 Itinera Hierosolymita et descriptiones Terrae sanctae, ed. T.  Töbler and A.  Molinier (Geneva:  1880), Vol. I, p.  302. See F.-​O. Touati,

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‘Raban Maur et la médecine carolingienne’, in P. Depreux, S. Lebecq et al. (eds), Raban Maur et son temps (Turnhout: Brepols, 2010), pp. 173‒202; and F.-​O. Touati, ‘La Terre sainte: Un laboratoire hospitalier au Moyen Age?’, in N. Bulst and K.-​H. Spiess (eds), Sozialgeschichte mittelalterlicher Hospitäler (Ostfildern:  Jan Thorbecke, 2007), pp. 169‒211. 25 J. E. Zias, ‘Leprosy in the Byzantine monasteries of the Judean Desert’, Koroth, 9(1‒2) (1985), 242–​8; V. Møller-​Christensen, ‘Evidence of leprosy in earlier peoples’, in D. Brothwell and A. T. Sandison (eds), Diseases in Antiquity (Springfield, IL:  C. C.  Thomas, 1967), pp. 295–​307; C. Dauphin, ‘Leprosy, lust and lice:  Health and hygiene in Byzantine Palestine’, Bulletin of the Anglo-​Israel Archaeological Society, 15 (1996–​97), 55–​79. 26 Life of St Theodosios, ed. H. Usener, in Der heilige Theodosios: Schriften des Theodoros und Kyrillos (Leipzig:  Teubner, 1890); trans. A. J. Festugière, Les moines d’Orient (Paris: Editions du Cerf, 1962), III/​2, pp. 83‒160 (XL, 14‒18); and Vie de saint Euthyme, in Festugière, Les moines, III/​1, p. 107, XXV, 5‒7. 27 M. Avi-​ Yonah, ‘The bath of the lepers at Scythopolis’, Israel Exploration Journal, 13 (1963), 325‒6. 28 T. S. Miller, The Birth of the Hospital in the Byzantine Empire (Baltimore: Johns Hopkins University Press, 1985), pp. 22, 93, 125–​6, 134–​6; P. J. Fedwick (ed.), Basil of Caesarea:  Christian, Humanist, Ascetic (Toronto:  Pontifical Institute of Mediaeval Studies, 1981); D. J. Constantelos, Byzantine Philanthropy and Social Welfare (New Brunswick: Rutgers University Press, 1968), pp. 154–​7, 181–​3; John Chrysostom, Consolatio ad Stagyram, Patrologia graeca (hereafter PG), 47, cols 490‒1. 29 ‘Zôticos de Constantinople, nourricier des pauvres et serviteur des lépreux’, ed. M. Aubineau (Bibliotheca Hagiographica Graeca 2479), Analecta Bollandiana, 93 (1975), 67–​108. 30 G. Sidéris, ‘Lèpre et lépreux à Constantinople:  Maladie, épidémie et idéologie impériale à Byzance’, in L. Buchet, C. Dauphin and I. Séguy (eds), La paléodémographie: Mémoire d’os, mémoire d’hommes. Actes des 8e journées anthropologiques de Valbonne (Antibes:  APDCA, 2006), pp. 187‒205, esp. pp. 192‒5, 197. 31 Corpus des sceaux de l’empire byzantin, ed. V. Laurent, V, 3 (Paris:  CNRS, 1972), p.  220 (no.  1916); Sidéris, ‘Lèpre et lépreux’, p.  202. The seal is reproduced in Miller and Nesbitt, Walking Corpses, p. 87. 32 Michael Psellos, Chronographie, ed. and trans. E. Renauld (Paris: Les Belles Lettres, 1926), I, IV, 35, p. 74.

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33 ‘Zôticos de Constantinople’, p. 85, §14. 34 G. Le Strange, Palestine under the Moslems (London: Alexander P. Watt for the Committee of the Palestine Exploration Fund, 1890), p. 371. On Saint Francis, see C. A. Krolikoski, Chapter 9 in this volume; and F.-​O. Touati, ‘François d’Assise et la diffusion d’un modèle thérapeutique au XIIe siècle’, Histoire des sciences médicales, 16 (1982), 175‒84. 35 P. Gautier (ed. and trans.), ‘Le typikon du Christ Sauveur Pantocrator’, Revue des études byzantines, 32 (1974), VIII, 110‒13. 36 Sidéris, ‘Lèpre et lépreux’, p. 193. 37 F.-​O. Touati, ‘Entre Orient et Occident: Les archives de Saint-​Lazare de Jérusalem au Moyen Age’, in G. Brunel and A. Nielen (eds), La présence latine en Orient au Moyen Age (Paris:  Centre historique des Archives nationales-​ Honoré Champion, 2000), pp. 95–​ 129; F.-O. Touati, ‘De prima origine Sancti Lazari Hierosolymitani’, in D. Coulon, C. Otten-​Froux, P. Pagès et  al. (eds), Chemins d’outre-​ mer: Etudes d’histoire sur la Méditerranée médiévale offertes à Michel Balard, Byzantina sorbonensia, 20 (Paris: Publications de la Sorbonne, 2004), pp. 801‒12, http://​books.openedition.org/​psorbonne/​3907/​ (accessed 11 October 2020). 38 P. Magdalino, Constantinople médiévale:  Etudes sur l’évolution des structures urbaines (Paris: De Boccard, 1996), p. 85. 39 See Part III of this volume. 40 Sidéris, ‘Lèpre et lépreux’, p. 203. 41 Liber in gloria confessorum, MGH, SRM, I, 2, p. 802; Vitae patrum, I, 4, MGH, SRM, I, p. 666; Vitae patrum, III, p. 180. 42 Venantius Fortunatus, Vita sanctae Radegundis, I, 19, PL, 72, col. 658; Touati, Maladie, pp. 88, 91. 43 AASS, 30 August, II, p.  310; MGH, SRM, IV, p.  441, 448; AASS, October, VIII, pp. 991–​3. 44 Liber in gloria martyrum, MGH, SRM, I, 2, p. 49, §18. 45 Historia francorum (Libri historiarum decem), X, 15, MGH, SRM, I, 1, p. 504. 46 Vita S.  Athanasii episcopi Neapolitani, MGH, SRL, p.  445; De pauperibus amandis, I, PG, 46, col. 468c. 47 Relatio de legatione Constantinopolitana, ed. J. Becker, MGH, SRG, p.  175; E. Patlagean, ‘La pauvreté byzantine au VIe siècle au temps de Justinien: Aux origines d’un modèle politique’, in M. Mollat (ed.), Etudes sur l’histoire de la pauvreté (Paris: Publications de la Sorbonne, 1974), pp. 80‒1. 48 Homelia XIX, in PL, 118, col. 138b; Touati, Maladie, p. 235.

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49 On the kissing of lepers, see Krolikoski, Chapter 9 in this volume. 50 Vie de Robert le Pieux:  Epitoma vitae regis Roberti Pii, ed. R.-​ H. Bautier and G. Labory (Paris:  CNRS, 1965), p.  126, §27; also, Rodulfus Glaber, Historiarum libri quinque, ed. J. France and N. Bulst, trans. P. Reynolds (Oxford:  Clarendon Press, 1989), IV, pp. 18–​19. On the relationship with the Holy Land, F.-​O. Touati, ‘Saint Lazare, Fontevraud, Jérusalem’, in J. Dalarun (ed.), Robert d’Arbrissel et la vie religieuse dans l’Ouest de la France, Disciplina monastica, 1 (Turnhout: Brepols, 2004), pp. 199–​238. 51 ‘De conversatione servorum Dei’, ed. B. Z. Kedar, Dumbarton Oaks Papers, 37 (1983), 72:  ‘Albericus itidem Ierosolymis leprosis inservivit. Is ea quae reliqua fecerant leprosi, comedit, singulos quotidie exacta Missa exosculatus est, pedes eorum lavit, tersit, stravit lectos, languentes humeris cubitum portavit. Cumque uni aliquando pedes lavisset, et aqua sanguine et sanie mixta ipsi nauseam moveret, protinus faciem immersit et partem non exiguam (horribile dictu) exhausit. Cella ipsi magis carcer voluntarius fuit, quam in qua viveret. Flagellis sese frequenter cæcidit, ita ut largus cruor distillaret. Preculas demurmurans vel humi stratus procubuit, vel in genua devolutus ita ut callos obducerent. Pane fuit contentus solo hordeaceo et aqua: cilicio asperrimo usus est, nudis indecens pedibus. Inæquali tonsura caput rasit et barbam, ut morionem crederes. Si quis seculares eum accedebant, aut mordaci dicacitate eos pupugit, aut superbe contempsit hypocrita.’ 52 Baldric of Bourgueil, PL, 40, cols 1118, 1147; also see ‘Actes et cartulaire de Saint-​Lazare de Jérusalem’, ed. F.-​O. Touati, unpublished dissertation (Université de Paris I, 2001), p. 70. 53 Guibert of Nogent, Dei gesta per Francos, ed. R. B.  C. Huygens (Turnhout: Brepols, 1996), VI, Prologue, p. 233; VII, §28, p. 322. 54 E. J. Kealey, Medieval Medicus:  A Social History of Anglo-​Norman Medicine (Baltimore: Johns Hopkins University Press, 1981), pp. 85–​7. 55 See F.-​ O. Touati, ‘ “Aime et fais ce que tu veux”: Les chanoines réguliers et la révolution de charité au Moyen Age’, in M. Parisse (ed.), Les chanoines réguliers:  Emergence et expansion (XIe–​XIIIe siècles) (Saint-​Etienne: Publications de l’Université, 2009), pp. 159–​210. 56 Touati, ‘La Terre sainte’, pp. 175‒80. 57 See above, nn. 43 and 44; Theodosius, De situ Terrae sanctae, ed. P. Geyer, CCSL 175 (Turnhout:  Brepols, 1965), §19; Anonymous of Placentia, Itinerarium, in Theodosius, Se situ Terrae sanctae, §§7, 5–​8 (Gadera) and §10, 1–​ 3 (Livias and Dead Sea); see translation by J. Wilkinson, Jerusalem Pilgrims before the Crusades (Warminster: Aris & Phillips, 1977), pp. 34, 69, 81‒2.

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58 Al-​Baladhuri, Kitab Futuh al-​buldan, ed. J. de Goeje (Leiden:  Brill, 1866), p.  129; M. W. Dols, ‘The leper in medieval Islamic society’, Speculum, 58 (1983), 898‒9; M. W. Dols, ‘Leprosy in medieval Arabic medicine’, Journal of the History of Medicine, 34(3) (1979), 314‒33. 59 Dols, ‘The leper’, 903, 907–​8. 60 See Touati, ‘Contagion and leprosy’.

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3 The disease and the sacred: the leper as a scapegoat in England and Normandy (eleventh–​twelfth centuries) Damien Jeanne In memory of René Girard Yet from the suffering of one who has done him no wrong he turns away as though it were a crime. Gregory of Nazianzus1

In the early and central Middle Ages, leprosy sufferers were represented and labelled in a range of different ways, ranging from words implying that they were impure or tainted (‘sacer’) to words emphasising their purity (‘sanctus’). How can we explain the odd phenomenon of a constant dichotomy in the way lepers were considered in medieval society? The lepers’ dual representation is all the more surprising in light of the close association of Christ with this group, as ‘Christus leprosus’.2 We may wonder: why do sources describe lepers as both the elect of God and transgressors of religious rules? Why are they excluded from the community, taken away from the gates of the towns and at the same time socially included through the care that they receive in leper houses? Could this strange opposition that wavers between glorification and relative rejection be explained by the scapegoat theory of the French historian and anthropologist René Girard (1923–​2015)?3 Girard argues that Christianity is based on the glorification of the victim –​ Christ –​accused of all evil and killed by the mob that attacks his body (Luke 23:12). But Christ’s resurrection ultimately reveals his innocence. That is the reason why humiliation that leads to glory is one of the fundamental values of medieval western society. This chapter addresses this dichotomy regarding the perception and treatment of lepers, focusing on both miracle accounts, in which

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lepers were healed, and on leper houses, which offered charity to lepers. The miracles under consideration are those of Thomas Becket, one of the small number of medieval saints credited with healing lepers. The leper houses reflect the generosity of clerical and secular donors, who considered lepers highly worthy recipients of their charity.4 The chapter pays special attention to the language associated with lepers and leprosy, and to what it reveals about the identities of sufferers. The discussion that follows does elect to use the word ‘leper’, since this reflects the vocabulary of medieval sources.

Negative leprosy Leprosy undoubtedly had negative associations in late antiquity and the early Middle Ages. The early Christian thinkers, such as the austere Tertullianus (c. 160–​220), saw leprosy as the incurable sign of adultery.5 Origen (185–​254) saw it as the sign of lust.6 Likewise, Lactantius (c. 245–​325) linked it to wanton desire: He [Christ], likewise, cleansed the sores and spots of polluted bodies. This was no mean exercise of His immortal power, and in truth it portented this, that His doctrine, by the instruction it has unto justice, would purify those defiled by the sores of sin and the stains of vices. For they, indeed, ought to be regarded as leprous and afflicted with elephantiasis whom limitless desires for crime or insatiable delights for wantonness drive and leave branded with a lasting sore because of the stains of their disgraces.7

According to Ambrosius of Milan (c. 340–​ 97), leprosy was associated with paganism and greed.8 Regarded as the consequence of the transgression of religious norms, it was sin incarnate. Some of these negative notions persisted in written works of the twelfth and thirteenth centuries. The Life of Saint Hugh of Lincoln recounts the case of Map, an Oxford archdeacon whose mighty pride drove him to crush other people as he sought more and more offices. He found retribution for his sins in being sorely afflicted with leprosy.9 Radical Gregorian reformers used leprosy (or pestilential illness) as a rhetorical foil.10 Gilbert Crispin’s De simoniacis (1102) denounced greed as a kind of leprosy.11 The story of the biblical King

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Ozias who had become a leper –​God’s punishment for usurping the function of priests –​was used in the attempts to reform the Church in the twelfth century.12 It is mentioned in Book VIII of John of Salisbury’s Policraticus (1159), and in a letter drafted by Thomas Becket in 1166 and addressed to King Henry II, though this letter may have never been sent.13 The negative associations of leprosy also permeated literature. A  number of twelfth-​and thirteenth-​ century courtly romances relayed negative descriptions of lepers, appealing to the emotional responses of audiences (see Béroul’s Tristan, as well as Ami and Amile, La queste del Saint Graal and the Roman of Jaufré). Such literature conjured pictures of lepers who were lecherous, ugly, greedy, deceptive and evil-​smelling, or had the evil eye. With the emergence of a positive image of lepers as a worthy focus of Christian charity superimposing the negative one from the late eleventh and early twelfth centuries, this accumulation of negative language is all the more curious. How can we explain such a contradictory phenomenon?

Separate to unite They are driven away from the cities, they are driven away from their homes, from the market-​place, from public gatherings, from the streets, from festivities from drinking parties, even  –​how they suffer!  –​from water itself. They neither share the flowing Springs with every one else nor are they permitted the use of rivers to rinse away their contamination; and the strangest thing of all is that we drive them away from our midst as pariahs on one hand, and on the other bring them back to us claiming that they are really harmless, but all the while denying them shelter and failing to provide them with basic sustenance, treatment for their wounds, and dressings for their sores as best as we can. And so they wander about night and day, helpless, naked, homeless, exposing their sores for all to see, dwelling on their former state, invoking the Creator, leaning on each other’s limbs in place of those they have lost, devising songs that tug at the heartstrings, begging for a crust of bread or a bit of food or some tattered rag to hide their shame or provide relief for their wounds. To them a kind benefactor is not someone who has supplied their need but anyone who has not cruelly sent them away.14

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The miracles associated with Thomas Becket did not mark the first appearance of the theme of the estrangement and segregation of lepers in medieval Christianity. In the early Middle Ages leprosy was addressed by the Church Fathers. In his homily spoken at Caesarea in 373, Gregory of Nazianzus described the de facto segregation imposed on lepers.15 The sight of them could bring four types of reaction:  fear, hostility, indifference, even unwholesome glee.16 Gregory’s art consisted of pulling apart the stereotyped ideas about lepers to convince his audience that they should take care of these sick people, to keep them from starving to death. Never would Gregory blame the lepers for their condition; instead, he gave them a human figure again, in the image of God.17 In a sermon preached a year earlier, Gregory of Nyssa bemoaned a similar hostility shown by the mob, such hostile rejection prompting the lepers to stick together: Such people as these [victims of elephantiasis] alone look only to one another and flock together with each other because of the similarity of their sufferings. They have become repulsive to all others, but out of necessity they are not repulsed by one another. Driven out from everywhere, they flow together to form their own people (demos).18

Segregated from the rest of the population and gathered together on account of their disease, these people made up a separate entity. Around 470, the poet Sidonius Apollinaris coined the phrase ‘colleprosus’ to refer to those companions in misfortune.19 Their association led to mutual help in their quest for food. However, lepers tended to be regarded as a burden on the population during lean times and were likely to be blamed for food shortages.20

To lose or keep face? Miracles double-​speak A particular set of sources is revelatory about attitudes to leprosy in the third quarter of the twelfth century. These are the accounts of miracles attributed to Thomas Becket, archbishop of Canterbury, following his death in 1170. The miracle stories were collected and written down in the 1170s by Benedict of Peterborough (collection compiled c. 1171–​ 73) and William of Canterbury (collection compiled c. 1172–​ 77), Benedictine monks at Christ Church,

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Canterbury.21 The miracles concerning lepers have a very similar structure: in the first part the leper has been stigmatised as a result of the ‘contāgio’ and has experienced a loss of identity; in the second part the leper’s previous identity is restored after being healed and purified by the saint. It is vital here to consider what Benedict of Peterborough and William of Canterbury meant when they referred to ‘contāgio’. In classical Latin, this word means contact, or epidemic. Did medieval learned authors regard leprosy as contagious? Up to the thirteenth century, medical writers did not seem to entertain the notion of the external propagation of the disease,22 but more often presented the idea that it originated and developed internally within the patient’s body.23 However, ‘contāgio’ has another meaning in the context of medieval Christianity, referring to the stain of crime and sin. When the compilers of Becket’s miracles used the word ‘contāgio’ it may well have had this moral sense, signifying the spread of public rumour about a person and that person’s association with sin, which was understood to contaminate the social body.24 In medieval society, reputation (‘fama’25) was founded upon speech. Honour and dishonour were synonymous with good reputation and loss (shame). They were the obverse and the reverse of the same coin. Honour was first and foremost a dignity that existed only in the eyes of others; it was a good that had to be defended. It was not reserved only for royalty and aristocrats. The head and face, areas of the body where the effects of leprosy were most visibly apparent, were very sensitive areas with respect to honour. This notion is ambiguous: as Patricia Skinner points out, a disfigured king, in an honourable circumstance, does not lose face. On the other hand, if a person’s honour is damaged, it must be restored through a proper ritual, such as penance.26 The idea of contagion marks the loss of the leprous person’s reputation or honour, through allegations about him or her, transforming his or her identity. Rumour was certainly a powerful force in causing individuals to be labelled as lepers. The vita of Haimon de Savigny (who died in 1173 and was later beatified), written in about 1173–​ 86, informs us: ‘And actually, the rumour about his being a leper started spreading from mouth to mouth, inside and outside, and when it had travelled for some time among the crowd, it reached his very ears.’27

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Although the excerpt from Haimon de Savigny’s vita describes the circulation of a rumour within a crowd, there are very few instances of crowds acting with hostility towards the sick or disabled in medieval Europe.28 Yet aspects of public shame are hinted at in the collections of miracles attributed to Saint Thomas Becket. William of Canterbury’s text reveals that the marks of leprosy were not only manifested on the body: sufferers also lost their honour and social rank.29 William, son of Droco, from Argentan,30 contracted leprosy before turning fifteen. This young adult male, dubbed, but not a father yet,31 became a ‘disfigured’ man, monstrous because the pathology and the sin associated with leprosy were not differentiated. The butt of public disgrace, he had to leave Argentan and seek assistance at the shrine of Thomas Becket. Droco was the father of William, a young man, born in Argentan in the county of Neustria. He had not reached the full years of puberty when his face showed the obvious contagion of leprosy, and all his limbs too. Indeed, his discoloured face, knotty hands and ulcerous legs disfigured the individual and made him half the time the butt of his fellow-​citizens’ hatred. While his father was afraid of being near him, and his countrymen dreaded his appearance, his native town forsook him; running away from those who could not bear him any longer, he crossed the sea and entrusted himself to the martyr’s mercy.32

Another instance relates to a leprous monk. A  letter supporting the canonisation of Thomas Becket, recorded in William of Canterbury’s text, reveals that the Augustinian prior and monks of Taunton, Somerset moved John ‘the King’, a monk suffering from leprosy, out of their community, for fear of the ‘risk’ posed by the disease. The danger mentioned seems to have been that a monk no longer able to comply fully with the tenets of the monastic rule set a bad example. Lest his presence should cause scandal, they arranged for him to be accommodated first in a poor house, and subsequently in a leper house. A  note in that letter helps us to understand the decision. Co-​habiting with a leper was understood to bring the evil eye33 (‘invidere’) upon the rest of the community. John would now live apart in the company of his fellow-​sufferers. Thus, by the judgement of God, he was smitten by a serious and manifest form of leprosy. From that moment, we were afraid of the

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danger of that disease and set him apart from the community of our brethren; we entrusted his care to a poor house in the vicinity of our church, supplying all the necessaries for his well-​being … A particular John, nicknamed the King, started wasting away, losing his hair and his beard, and being deformed by tumours; he lived yet another two years in the Taunton house, our brothers partaking of his suffering as much as his disabilities made it possible. But as the disease carries the evil eye to the co-​habitants, he was removed to a hospice for patients suffering from the same evil.34

Another miracle account in William of Canterbury’s collection reveals the removal of a leprosy sufferer who inspired much repulsion from another religious context, an oratory. A  Welsh leper, driven away everywhere, only found comfort in the tears that washed his soul, before the process of purification was fulfilled by the martyr himself:35 A particular leper, extremely repulsive-​looking, avoiding our world as a result of the disease, a native of the Welsh borders, was expelled from an oratory. Away from his home for some time, with him he brought nothing but tears. But when he delayed, the martyr washed him, and by cleansing the blemishes on his face he made him whole.36

Thomas Becket’s sanctification resulted from his martyrdom and the number of miraculous healings that were reported to have taken place at his shrine. His violent death was sublimated by the prodigies that took place around his tomb, a place of reconciliation and healing.37 There is a parallel between the violence undergone by Thomas and the suffering and rejection experienced by lepers. Furthermore, the leper could only be redeemed through having recourse to the purification operated by Thomas.38 The violence of the assassination and that of the disease were interchangeable, since both were impure.39 To proceed towards purification, the sick person had to associate with the very symbol of violence  –​ blood –​equally emblematic of Thomas’s and Christ’s deaths. The documents refer to ‘vinage’,40 a mixture of blood, water or wine drunk by the sick at Becket’s shrine to purify themselves. This ‘vinage’ is reminiscent of the consecrated wine that is taken during Mass. William of Canterbury recounted that: We have seen two men whose purification was perfect, and who kept no sign at all of leprosy; they had received no other medicine than the

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water and the blood of the martyr; one of them lived near the tomb of the said martyr, eating and drinking what we had around there; his name was Richard, and he was admired by the kings, the earls, the natives and the foreigners who came to pray.41

There is a 54 per cent occurrence of the word ‘mundus’ (clean) in miracle accounts relating to leprosy in William of Canterbury’s volume, and 70 per cent in Benedict of Peterborough’s book (see Table  3.1).42 With another word, ‘sanitas’, a double meaning is present, since the word refers both to good health or healing and to purity. As it is, the role of the cathartic ritual is to ‘mislead’ violence.43 Making lepers clean consists of making them healthy again. The miracle negated the sacrificial value of the patient as a potential victim of the unleashed crowd. It worked peace among the community, expelled the idea of persecution and stood for the resurrection of a doomed individual. Thanks to the saint’s ‘præsentia’ (intervention), the healed individual was reintegrated into society.44 The miracles played a social role by making a sick person clean, and restoring that person’s previous social identity.

The language of separation One-​third of the Becket miracles relating to leprosy mention the separation of a leper from his or her village, spouse, monastic community or even leper brotherhood before travelling to the saint’s shrine. There are several types of estrangement, from that involved in joining a leper house to that of embarking on pilgrimage to the shrine at Canterbury. William of Canterbury prefers to use the verb ‘segregare’ to suggest an estrangement, a setting apart. An oblate from the Benedictine abbey of Abingdon, Oxfordshire, having become leprous, is set apart in a ‘neighbouring xenodochium [hospice]’.45 As we have seen, John ‘the King’, the Augustinian canon from the priory at Taunton, was first entrusted to the care of a ‘poor house’ next to the abbey church but was then transferred to a xenodochium to live with other lepers.46 In the poor house, he was separated, but remained close to the usual living quarters of his fellow monks. The vocabulary of segregation in William of Canterbury’s text and that of Benedict of Peterborough is predominantly non-​aggressive (see Table  3.2). The verbs used

–​

‘obiter mundari coepit’ ‘decem leprosos mundat’ ‘mundari meruit’ ‘manus mundavit’ ‘mundari meruit’ ‘et extergens maculas faciem mundavit’

‘mundationis reservantem’ ‘carnis mundationem’

‘Per merita beati Thomae Cantuariae mundatum’ ‘ad curatorem tuum mundata’ ‘mundatus est’ ‘Nos vero vidimus duos ad unguem mundatos nec signum leprae reservantes’ ‘mundatus est’ ‘unde mundatus Cantuariae’

‘spiritualiter munditia quaerenda est’

Emundare

Mundare

Mundatio

Mundatus

Munditia

William of Canterbury

(22) p. 337

(20) p. 332 (18) p. 431 (56) p. 458

(52) p. 214 (55) p. 216 (18) p. 330

(62) p. 221 (19) p. 431

(58) p. 220 (63) p. 222 (24) p. 339 (84) p. 480 (85) p. 480 (164) p. 541

–​

Sourcesa

Table 3.1  Words of purification in Thomas Becket’s miracles relating to leprosy

(III) p. 183

Sourcesb

–​

‘non plene mundatus’ ‘se sensit mundatus’ ‘mundatus est’

–​

–​ (continued)

(XXVIII) p. 203 (LXXIII) p. 244 (LXXVI) p. 245

–​

‘leprosos mundari’ (IV) p. 184 ‘ventris fluxu mundatur’ (LXXV) p. 245 (IV) p. 260 ‘ut mundus a mundi sordibus mundaret immundos’

‘ut penitus emundatus cogitaret de reditus’

Benedict of Peterborough

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‘consultis medicis, postquam sanitatis illius assertoribus’ ‘Vestigia penitus infirmitatis non amovit, sed notas quasdam in testimonium demolitae pestis collataeque sanitatis reservavit’ ‘Sic subarrhata pignore sanitatis’ ‘Nam sanitati restitutus post paucos dies’ ‘Si enim tantopere sanitas corporis elaborantur’ ‘tua sanitatem’ ‘unde gratam et optatam sanitatem perfecte suscipere meruit’ ‘sicque infra breve tempus caro ipsius fere pristinae restituta est sanitati’ ‘restituta est sanitati’ ‘recepit sanitatem’ ‘sanitatem adeptus est’ ‘est effectum sanitatis’

‘curatus et sanus’

‘Nam manuum et femorum impetiginosa sanie desicata, inflationumque tuberibus explosis, frucantibus jam superciliis, vultusque renascente gratia’

Sanitas

Sanus

Renascor

William of Canterbury

Table 3.1  (Cont.)

–​

Benedict of Peterborough

(53) p. 215

–​

(57) pp. 458–​9 ‘Ecce sanus factus es’

(23) p. 340 (25) p. 340 (17) p. 429 (19) p. 432 (83) p. 479

(54) p. 216 (55) p. 217 (56) p. 219 (19) p. 332 (20) p. 337 (22) p. 338

(53) p. 214

Sourcesa

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(IV) p. 260

–​

Sourcesb

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‘ut lepra putaretur’

‘Advenisti semel lue leprae contaminata; redire debueras vel semel ad curatorem tuum mundata’ ‘medico curandam reliquit’ ‘curat igitur omnem lepram’

‘Ut quod factum est ad curationem iteraretur iterum ad laudem’ (55) p. 216 (61) p. 221 ‘ad propia revertens curationis suae retulit indicia’.

‘eodem curatore cepit infirmitatis remedium’

‘curatae leprae’ ‘curati morbi’ ‘curatus et sanus’

Puto

Curo

Curatio

Curator

Curatus

bFrom

aFrom

‘Eadem nocte facies turgida subsedit’

Subsidio

–​

–​

–​

–​

–​

–​

–​

William of Canterbury, ‘Vita, passio et miracula s. Thomæ Cantuariensis archiepiscopi’. Benedict of Peterborough, ‘Passio sancti Thomæ Cantuariensis’.

(57) p. 220 ‘curatus fuerit’ (55) p. 457 (57) p. 458–​9

(60) p. 221

(55) p. 216 (19) p. 331 (20) p. 333

(83) p. 479

(59) p. 221

(21) p. 336

‘ad usque ad tumorum et tuberum omnium repressionem’

Repressio

(59) p. 221

‘pustulae prominentes decreverunt’

Decresco

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(LXXII) p. 243

–​

–​

–​

–​

–​

–​

–​

Segrego

‘Segregarent eum in xenodochium vicinum’ ‘A cohabitatione illorum segregatum’ ‘Unde et nos, hujusmodi infirmitatis timentes periculum eum a coetu fratrum nostrorum segregatum ad quandam domus pauperum’ ‘Sed cohabitationi cum morbus invideret, in xenodochium simili morbo laborantium segregatus est’ ‘Is factus leprosus, judicio cleri et populi, ut moris est, a coetu publico segregatus’ ‘A coetu communi segregatus fratribus simili morbo laborantibus cohabitasset’ ‘Ab eodem sancto propter eundem morbum a convicaneis suis segregatus juvenis Hugo’

Expello ‘Unde rursus a domo consulis ex praecepto ejus Expulsio expulsus est’

William of Canterbury

(85) p. 480

(84) p. 480

(57) p. 458

(18) p. 430

Sourcesb

(IV) p. 184 (LXXV) p. 245

‘Donec tandem manifesta (LXXIII) p. 243 (LXXVI) p. 246 colluvione tristem expulsionis suae excepit sententiam’ ‘Et a villa matre sola illum, ne periret, expulsus est’

Benedict of Peterborough

(52) p. 218 ‘Ab hominum segregari (57) p. 220 consortio’ ‘Segregatur a communione scholarium’ (17) p. 429

(22) p. 337

Sourcesa

Table 3.2  Words denoting the segregation or removal of lepers in Thomas Becket’s miracles

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bFrom

‘Sequestrandus erat a communi hominum’

(LXXIII) p. 243

‘Qui de convictu cum (III) p. 182 leprosis locutus, dum sui sollicitus de villa maturare cogeretur egressum’

William of Canterbury, ‘Vita, passio et miracula s. Thomæ Cantuariensis archiepiscopi’. Benedict of Peterborough, ‘Passio sancti Thomæ Cantuariensis’.

–​

Sequestro –​

aFrom

–​

–

Cogo

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to describe the leper’s estrangement (‘segregare’, ‘sequestrare’) are relatively soft terms, and are preferred to stronger verbs of ‘driving away’ or ‘banishing’ (‘expellere’), or driving forcefully away (‘cogere’). We may talk about weakened texts of persecution in so far as nobody gets killed.47 Let us consider a few further examples from the Becket miracles. Described as the son of a ‘needy woman’ (‘mulieris pauperculae filius’), and yet brought up in the familia of a rich knight, Richard Sunieve suffers from leprosy.48 He must be evicted from his master’s household and expelled from the village. His mother alone will provide for his needs. Benedict of Peterborough states: And God gradually spread His hand over him for eight years and He touched him, and all his body was infected with leprosy, and his flesh hurt in painful wounds. At last, as he had become a burden and a source of horror for all, merely by his being alive, he was not only expelled from the miles’ household but also from the village. His mother alone accompanied him lest he perished.49

Here, the issue was not fear of contamination, but the fact that looking at the sick boy had become unbearable. This feeling of repulsion could affect all forms of community life:  a knight’s household, a village, a monastery. In another example, recounted by William of Canterbury, a lay brother at Boxgrove priory in Sussex50 awaited divine healing: ‘For two years a certain Godwine, a servant of the monks of Boxgrove, had been leprous (“elephantiosus”); he had gone seeking the heavenly physician; and until he could find Him, he begged that no weariness, no disgust, no repulsion be encouraged.’51 The lay brother expected to be the target of hostility within his monastic community, and begged the monks to refrain from treating him with negativity.

Leprosy as divine kindness and purification ‘Whoever makes himself high will be made low’ (Matthew 23:12). In the Middle Ages, sickness was perceived as a moment of humiliation and indignity, for God’s power was made stronger in weakness. The Letter to the Hebrews (12:1–​13), the figure of Job, or the song of the suffering Servant (Isaiah 52:13–​25; 53:1–​12)

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were the bases of eschatological thought on the meaning of disease. The Christian ethics of sickness invited the sick person to rejoice in his or her condition. In a letter written c. 1070–​89 to the monk Gilbert, who was suffering from a pulmonary infection, Archbishop Lanfranc of Canterbury (d. 1089)  asked him to be thankful to God for the grace granted to him, for in weakness God’s power is manifest. Sickness was a divine correction that enabled one to know oneself and accept the humbleness of one’s condition. When I  read your letter Brother, I  realised that you were suffering from a serious illness. I urge you not to grieve over that but to rejoice and to render unwearied thanks to your Creator for this care for you, knowing that is written ‘Most gladly will I glory in my infirmities.’52 And elsewhere:  ‘God scourgeth every son whom he received.’53 He would not be scourging you so severely in this life were he not intending that after this life you should be free from scourging. So examine yourself, think on your last hours and confess your sins. If you do this, either you will receive physical health from God or you will await death without fear, terrible as it is to others; because for you it will be the end of evil and the beginning of good.54

Sickness was seen as a privileged means of conversion, all the more so as life expectancy in this period was low.55 While the human body had been granted positive value by the very fact that Christ, through the Incarnation, had totally assumed man’s nature, the fate of the soul after death was of greater importance than the health of the body.56 Leprosy was the lowest degree of humiliation, akin to crucifixion. From the fifth century, Saint Jerome, in his commentary of the suffering servant, identified the sufferings of Christ on the Cross with those of the leper (‘and we took him for a leper, and struck by God and humiliated’).57 The idea of Christ the Crucified finding his counterpart in a leper was a prominent theme of redemption. From the tenth century onwards, Christianity emphasised Christ’s suffering, with the image of Christ the Crucified or Suffering replacing that of Christus triumphans of the previous centuries.58 Following in Saint Augustine’s footsteps,59 Abbot Gerbert of Saint-​ Wandrille (1063–​ 89) could exalt a ‘Jesus in his glory, magnificent, practically a leper’.60 Praying to be afflicted with leprosy was a way of imitating Christ. Leprosy had the power to generate a unique state of spiritual exaltation. The leprous body

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was becoming the object of a form of compassionate obsession at a time when the relationship with one’s body was becoming more ascetic, as reported by Orderic Vitalis (c. 1075–​1141): As for Ralph the fifth brother (of Giroie), he was nicknamed ‘the clerk’ because he was thoroughly versed in grammar and the other liberal arts. He was also called ‘Ill-​tonsured’ because of his predilection for knightly sports and frivolities in his youth … Finally he gave up the pleasures of the world and sought refuge at Marmoutier, where he took vows under Abbot Albert and humbly implored God to afflict his body with an incurable leprosy so that his soul might be cleansed from his foul sins. His prayers were answered, and almost six happy years after his conversion, he died.61

Being cursed with leprosy brought the sufferer closer to the monk’s status as a servant of God.62 In the twelfth century, lepers living in a community called themselves collectively ‘humiles servi Dei’ (‘humble servants of God’), like for instance the lepers of Saint-​ Gilles at Pont-​Audemer (Normandy), or those of Saint-​Jacques du Bois Halbout (Normandy).63 This is no isolated occurrence of the phrase. Lepers were living images of Christ who ‘did not come to be served, but to serve’.64 According to Chapter  7 of the rule of Saint Benedict, the monk had to rejoice in his mean position and proclaim himself the meanest of all by saying with King David ‘But I am a worm and not a man; cursed by men and despised by the people’ (Psalms 22:7).65 By being the most dreaded outcasts, lepers were closest to Christ, as Hugh of Amiens, archbishop of Rouen (1130–​64) wrote to the lepers of Saint-​Gilles of Pont-​Audemer in 1150.66 Perceived as a God-​given grace (‘voluntate Dei leprosus’), the affliction of leprosy was understood as a joyful process towards self-​abasement and salvation.67 A symbol of humility and obedience, the disease was both evil and remedy. Ralph, brother of Giroie, was wishing for sores so as to be cleansed from his sins. A similar paradox is to be found in the writings of Hugh of Saint-​Victor (c. 1096–​1141) or William of Auxerre (d. 1231).68 What can a much observed but seldom explained ambiguity reveal?69

A sacred leprosy? In leprosy, poison and remedy co-​exist. It is as though the disease worked as a pharmakon. The word pharmakon is used to describe

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both the toxic drug and the antidote. A pharmakon’s very essence is its instability and ambivalence; its very reversibility deprives it altogether of a true identity.70 It was necessary to differentiate (discernere) different kinds of leprosy from each other:  mythical leprosy from pathological leprosy, leprosy as punishment from leprosy as blessing, leprosy as a source of pollution from leprosy as a source of redemption. Leprosy required separation, distinction, prohibition, but also established a very close connection with the sacred.71 Leprosy, being its own antagonist, signified a conflictual set of dichotomies. Jesus, ‘denounced as a leper’, cleanses lepers of any sin thanks to the purification he provides. To sum up, the Leper heals the leper. Around the year 400, Saint Jerome was one of the first Christian writers to suggest that the leper was mimetic, as Jesus’s alter ego. Lepers were mimetic in their experience of rejection, mimetic in their sufferings, mimetic in their innocence of the sins of which they were accused: Jesus and the leper were but one. The image of this fusion gained increasing currency in the eleventh century,72 hence the need to differentiate the different kinds of leprosy from each other. A number of clerics addressed that question: Saint Bernard in his De præcepto et dispensatione (c. 1128), Gratian in his Decretum (c. 1140), Richard of Saint-​Victor in his De potestate ligandi et solvendi (after 1162)  and Jacques of Vitry in a letter of 1217.73 Knowing how to discern one kind of leprosy from another consisted of dissociating the scandal of sin from conversion, punishment from election. The role of priests was not then to condemn lepers, since Christ had purified them, but to lead them to conversion.74 A difficult task, judging by the sermons left by the Greek Church Fathers. Yet leprosy continued to be associated with scandal in the central Middle Ages, especially in a society where reputation was vitally important.75 Scandal was a dangerous force, since further scandal tended to spread around it.76 To avoid skandalon  –​ the trap, the obstacle –​and maintain community cohesion,77 a clear line needed to be drawn between cursed and blessed leprosy. Hugh of Saint-​ Victor (d. 1141) wrote: This leper is the human race, which, while it was leprous, was separated and far distant from God and the city of God, that is to say Jerusalem which on high is our mother. But the Lord … has healed the leper, and made him a citizen of his city. Nor does the

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Approaching leprosy and identity Lord disdain to perform this miracle every day through His grace. For there are, indeed, many within the body of the Holy Church who are befouled by the leprosy of vice and polluted by the contagion of sins, as by leprosy. All the impure, fornicators, concubines, the incestuous, adulterers, the avaricious, usurers, false witnesses, those who call a brother ‘fool’, and who look lustfully upon a woman, and even those who do not perform wicked acts, but harbour wicked desires: all such people, who are isolated from God because of their faults, are deemed to be leprous by the priests, who know and keep the law of God, and they are therefore separated from the company of the faithful in a spiritual, but not physical sense.78

Hugh of Saint-​Victor not only assimilated the leper’s condition to that of the whole human race awaiting redemption.79 His text goes further by evoking the toxic nature of leprosy, which contaminates the community. He refers to leprosy as a metaphor for other contaminating sins. However, this nefarious leprosy could be cleansed by the purifying action of a Christ who blotted the scandal out and brought the sick person back into the community. Catharsis here no longer comes from the eviction of the leper, but rather from his or her continuing inclusion in the social body thanks to leper houses. These institutions protected lepers from any potential ostracism or violence, since their residents did not have to wander or beg. Within leper houses, it is ultimately not the lepers who are offered hospitality but rather others who receive a welcome from the leprous, through the efficacious prayers provided by the latter.80

Conclusion The stereotypes that shaped responses to lepers belonged both to the field of sacer (archaic violence) and to that of sanctus (where lepers living within a leper house were acknowledged as worthy penitents). A number of contemporaries of the eleventh to thirteenth centuries recognised the dichotomies that surrounded leprosy. For example, in a charter of 1150 for Saint-​Gilles of Pont-​Audemer, Hugh of Amiens played on the lexical opposition of abjectiores (‘more rejected’) with proximiores (‘more near’) to give a clearer

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description of the leper’s ambivalent position. Humiliated by the disgrace brought upon them by the disease, honoured by the divine grace brought by that same disease, lepers were genuine living martyrs representing the incarnation of the suffering Christ.81 The Christian thinkers of the early Middle Ages warned their flocks against sin and wanton desire, which they connected to leprosy. At the same time, they exhorted an indifferent or hostile population to care for lepers. By the twelfth century, the Church wanted to avoid vagrancy and begging by lepers, and therefore appealed to public charity to finance shelter, food and appropriate medical care within the protective walls of the leper houses. The Church Fathers had striven to decrease the nefarious reputation of the lepers by turning them into ‘christomimetic’ beings. From the later eleventh and twelfth century, the leper’s religious conversion took place through his or her admittance into the leper community. Within the leper house, the leper became a meek and innocent lamb, as well as a penitent who played a vital role as an intermediary between God and those seeking their future salvation. At this point in time –​even if in later centuries responses to the leprous were not uniformly positive82 –​the ritualised protocol that the leper followed upon entering a leper house means that the leper should not be considered an authentic scapegoat.83

Notes 1 Saint Gregory of Nazianzus, Select Orations, ed. M. Vinson (Washington, DC: Catholic University of America Press, 2003), p. 47 (Oration 14). 2 Mark 1:40–​5. 3 R. Girard, Le bouc émissaire (Paris: Grasset, 1982). 4 F.-​O. Touati, ‘La géographie hospitalière médiévale (Orient–​Occident, IVe–​XVIe siècles):  Des modèles aux réalités’, in P. Montaubin (ed.), Hôpitaux et maladreries au Moyen Age:  Espace et environnement (Amiens: CAHMER, 2004), pp. 7–​20. 5 Tertullianus, La pudicité, XX, 6–​7, ed. C. Micaelli and C. Munier, 2 vols (Paris: Cerf, 1993), Vol. I, pp. 265–​7. 6 Origen, Homélies sur le Lévitique, VIII, 5–​8, ed. M. Borret, 2 vols (Paris: Cerf, 1981), Vol. II, pp. 29–​41.

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7 Lactantius, The Divine Institutes:  Books I–​VII, Book IV, 26, in The Fathers of the Church, ed. M. F. McDonald (Washington, DC: Catholic University of America Press, 1964), p. 310. 8 Ambrosius of Milan, Traité sur l’Evangile de Luc: Livres I–​VI, ed. G. Tissot (Paris: Cerf, 1956), 1: IV, 51, 171; IV, 53–​4, 172–​3; V, 5, 184. 9 ‘This caused general surprise, but when a little later this clerk was found to be badly infected with leprosy, a just retribution for his sins.’ Magna vita sancti Hugonis: The Life of St Hugh of Lincoln, Book V, Chapter 10, ed. D. L. Douie and H. Farmer, Vol. II (London: Nelson, 1962), p. 131. 10 J.-​H. Foulon, Eglise et réforme au Moyen Age:  Papauté, milieux réformateurs et ecclésiologie dans les pays de la Loire au tournant des XIe–​XIIe siècles (Brussels: De Boeck, 2008), p. 365. 11 Gilbert Crispin, De simoniacis, ed. Joseph Armitage Robinson, in Gilbert Crispin, Abbot of Westminster: A Study of the Abbey under Norman Rule (Cambridge:  Cambridge University Press, 1911), pp. 111–​24 (p. 113). 12 2 Kings 15:5; 2 Chronicles 26:16–​21. 13 John of Salisbury, Policraticus:  Of the Frivolities of Courtiers and the Footprints of Philosophers, ed. and trans. C. J. Nederman (Cambridge:  Cambridge University Press, 2006), pp. 214–​ 15; The Correspondence of Thomas Becket, Archbishop of Canterbury, 1162–​ 1170, ed. and trans. A. J. Duggan, 2 vols (Oxford: Clarendon Press, 2000), Vol. I, pp. 334–​6 (letter 82). 14 Gregory of Nazianzus, Select Orations, p. 47 (oration 14). 15 ‘There lies before our eyes a dreadful and pathetic sight, one that no one would believe who has not seen it: human beings alive yet dead, disfigured in almost every part of their bodies, barely recognisable for who they once were or where they came from.’ Gregory of Nazianzus, ibid., p. 45 (oration 14). 16 Cf. Saint John Chrysostom, Homily XXI, 6, in Homilies of St. John Chrysostom archbishop of Constantinople. On the First Epistle of St. Paul the Apostle to the Corinthians, trans. John Henry Parker, Vol. 1 (Oxford: Parker, 1889), p. 289: ‘And thou, while these things are going on, standest laughing, and wondering the while, and making a fine show of other men’s miseries, our common nature disgracing itself.’ 17 Gregory of Nazianzus, Select Orations, p.  49 (oration 14). Also see Leviticus:  M. Douglas, L’anthropologue et la Bible:  Lecture du Lévitique, trans. Jean L’Hour (Paris: Bayard, 2004), p. 214. 18 ‘Gregory of Nyssa’s oration regarding the words “As much as you have done for one of these, you have done for me” (Matt. 25:40)’, in T. S. Miller and J. W. Nesbitt, Walking Corpses: Leprosy in Byzantium

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and the Medieval West (Ithaca, NY: Cornell University Press, 2014), p. 177. 19 In the relevant letter of Sidonius Apollinaris, ‘colleprosus’ was a rhetorical figure, but the word still probably reflected social realities. Sidonius Apollinaris, Lettres (livres VI–​IX), Vol. III, ed. André Loyer (Paris: Société d’édition ‘Les Belles Lettres’, 1970), VI, 2–​8. 20 G. Sidéris, ‘La lèpre et les lépreux à Constantinople: Maladie, épidémie et idéologie impériale à Byzance’, in L. Buchet, C. Dauphin and I. Séguy (eds), La paléodémographie: Mémoire d’os, mémoire d’homme (Antibes: Editions APDCA, 2006), pp. 194–​6. 21 On Thomas Becket’s cult and the miracle collections associated with his shrine, see: R. Koopmans, Wonderful to Relate: Miracle Stories and Miracle Collecting in High Medieval England (Philadelphia: University of Pennsylvania Press, 2011), Chapters 8, 9 and 10, and Appendices 1, 2 and 3; R. Koopmans, ‘Thomas Becket and the royal abbey of Reading’, English Historical Review, 131 (2016), 1–​30; P. Webster and M.-​P. Gelin (eds), The Cult of St Thomas Becket in the Plantagenet World, c. 1170–​c. 1220 (Woodbridge: Boydell Press, 2016); R. Foreville, ‘Les miracula S.  Thomæ Cantuariensis’, in Assistance et assistés jusqu’en 1610 (Paris:  Bibliothèque nationale, 1979), p.  444; D. Lett, ‘Deux hagiographes, un saint et un roi:  Conformisme et créativité dans les deux recueils de miracula de Thomas Becket’, in M. Zimmermann (ed.), Auctor et auctoritas:  Invention et conformisme dans l’écriture médiévale (Paris:  Ecole des chartes, 2001), pp. 202–​3; M. Staunton, Thomas Becket and His Biographers (Woodbridge:  Boydell Press, 2006), pp. 49–​55. 22 F.-​ O. Touati, ‘Contagion and leprosy:  Myths, ideas and evolution in medieval minds and societies’, in L. I. Conrad and D. Wujastyk (eds), Contagion: Perspectives from Pre-​Modern Societies (Aldershot: Ashgate, 2000), pp. 179–​201; Touati, Maladie, p. 143; V. Nutton, ‘The seeds of disease: an explanation of contagion and infection from the Greeks to the Renaissance’, Medical History, 27 (1983), 1–​34; Girard, Bouc émissaire, p. 31. 23 Touati, Maladie, p. 140. 24 Girard, Bouc émissaire, pp.  245–​ 354; P.  Froissart, La rumeur (Paris: Belin, 2010), pp. 250–​66. 25 C. Gauvard, ‘Honneur’, in Claude Gauvard, Alain de Libera and Michel Zink (eds), Dictionnaire du Moyen Age (Paris: Quadrige/​PUF, 2002), pp. 687–​9; C. Gauvard, ‘La fama, une parole fondatrice’, Médiévales, 24 (1993), 5–​ 13; P. Skinner, Living with Disfigurement in Early Medieval Europe (New York: Palgrave Macmillan, 2017), pp. 113, 131 n. 74; S. E. Phillips, Transforming Talks: The Problem with Gossip in

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Late Medieval England (University Park: Penn State University Press, 2007); T. Fenster and D. L. Smail (eds), Fama:  The Politics of Talk and Reputation in Medieval Europe (Ithaca, NY:  Cornell University Press, 2003). 26 C. Gauvard, ‘De grace especial’: Crime, Etat et société en France à la fin du Moyen Age (Paris: Publications de la Sorbonne, 2010), pp. 705–​ 39; I. Pânzaru, ‘Caput mystice: Fonctions symboliques de la tête chez les exégètes de la seconde moitié du XIIe siècle’, Le Moyen Age, 3–​4 (2001), 439–​53; Skinner, Living with Disfigurement, pp. 41–​66, 117; M. de Jong, The Penitential State:  Authority and Atonement in the Age of Louis the Pious, 814–​840 (Cambridge: Cambridge University Press, 2009). 27 ‘Fama etenim cœpit quod ipse leprosus esset evolare et in ore interiorum et exteriorum crebrescere. Cumque jam aliquamdiu per multorum volitasset ora, tandem haec de eo fama ad ipsum est delata.’ Vita B.  Hamonis, in ‘Vitæ Petri Abrincensis et B.  Hamonis, monachroum cœnobii Saviniacensis in Normannia’, ed. E.-​P. Sauvage, Analecta bollandiana, 2 (1883), 475–​560 (p. 503); D. Jeanne, ‘Lèpre humiliante, lèpre édifiante: Hamon de Savigny, novice réputé lépreux au service des lépreux’, in B. Galbrun and V. Gazeau (eds), L’abbaye de Savigny (1112–​2012): Un chef d’ordre anglo-​normand (Rennes: Presses universitaires de Rennes, 2019), pp. 305–​20. 28 The 1321  ‘Lepers’ plot’ is a rare instance of crowd violence against leprosy sufferers. M. Barber, ‘Lepers, Jews and Moslems:  The plot to overthrow Christendom in 1321’, History, 66 (1981), 1–​17; D. Nirenberg, Violence et minorités au Moyen Age, trans. N. Genet (Paris:  Presses universitaires de France, 2001), pp. 116–​54; Touati, Maladie, pp.  702–​29. On visual representations of the violence of 1321, see Luke Demaitre, Chapter 8 in this volume, pp. 241–2. 29 William of Canterbury, ‘Vita, passio et miracula s.  Thomæ Cantuariensis archiepiscopi’, in Materials for the History of Thomas Becket, ed. J. C. Robertson, 7 vols, Vol. I (London: Longman, 1875), pp. 214–​15. 30 Diocese of Sées. France, département Orne. 31 G. Duby, ‘Les “jeunes” dans la société aristocratique dans la France du Nord-​ Est au XIIe siècle’, in G. Duby (ed.), La société chevaleresque:  Hommes et structures du Moyen Age, Vol. I (Paris: Flammarion, 1988), pp. 129–​30. 32 ‘Adolescentis Willemi Droco pater fuit, patria Neustria, locus nativitatis Argentomium; qui nondum plene pubertatis implens annos planam in facie cæterisque membris lepræ contagionem prætendebat. Facies enim decolor, nodosæ manus, ulcerosæ tibiæ, virum dehonestabant,

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suisque conviventibus concivibus et dimidium temporis invidebant. Cujus cum quam cohabitationem pater, et patria formidaret aspectum, civitas ortum dissimularet, fugiens ille eos quibus onerosus erat, mari transmisso venit ad misericordiam martyris.’ William of Canterbury, ‘Vita, passio et miracula’, pp. 214–​15. 33 R. Girard, ‘Violence et représentation dans le texte mythique’, in R. Girard (ed.), La voix méconnue du réel:  Une théorie des mythes archaïques et modernes (Paris: B. Grasset, 2002), pp. 40–​1. 34 ‘Divino ita procurante judicio lepra gravi et manifesta fuisse percussum. Unde et nos, hujusmodi infirmitatis timentes periculum eum a coetu fratrum nostrorum segregatum ad quandam domum pauperum, ecclesie nostrae conterminam, providentes ei vitae necessaria delegavimus … Qui Johannes nominatus et Rex cognominatus, cum capillis et barba defluentibus deflorari et deformari tuberibus inciperet, adhuc in domo Tantonensi per biennum resedit, fratri fratribus quantum permitteret infirmitas compatientibus. Sed cohabitationi cum morbus invideret, in xenodochium simili morbo laborantium segregatus est.’ William of Canterbury, ‘Vita, passio et miracula’, pp. 429–​30. 35 P. Nagy, Le don des larmes au Moyen Age:  Un instrument spirituel en quête d’institution (Ve–​XIIIe siècle) (Paris:  A. Michel, 2000), pp. 195–​8. The Welsh leper benefited from the radiation of the saint’s protection. 36 ‘Quidam leprosus horrore nimio /​Apud nos solo vitandus vitio, /​Waliarum natus de confinio, /​Ejectus fuit ab oratorio. /​Qui post tempus modicum domum repedavit, /​Et nil præter lacrymas secum reportavit. /​Sed cum moram faceret martyr ei lavit, /​Et extergens maculam faciem mundavit.’ William of Canterbury, ‘Vita, passio et miracula’, p. 541. 37 R. Girard, Des choses cachées depuis la fondation du monde (Paris: Grasset, 2001), p. 231. 38 Girard, Bouc émissaire, p. 92. 39 R. Girard, La violence et le sacré (Paris: Fayard/​Pluriel, 2006), p. 47. 40 P.-​A. Sigal, ‘Naissance et développement d’un vinage exceptionnel: L’eau de saint Thomas’, Cahiers de civilisation médiévale, 44 (2001), 35–​44. 41 ‘Nos vero vidimus duos ad unguem mundatos nec signum lepræ reservantes, qui non aliud medicamen acceperant quam aquam et sanguinem martyris; quorum alter diutius circa tumbam ejusdem martyris conversabatur, edens et bibens quæ apud nos errant, Ricardus nomine, et erat spectaculum regibus, comitibus, indigenis et alienigenis oratum venientibus.’ William of Canterbury, ‘Vita, passio et miracula’, p. 332. 42 We have found seven cases for ten miracles.

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43 Girard, La violence, p. 59. 44 P. Brown, Le culte des saints: Son essor et sa fonction dans la chrétienté latine, trans. A. Rousselle (Paris: Editions du Cerf, 1984), p. 130. 45 P. H. Ditchfield and W. Page (eds), The Victoria History of the County of Berkshire, Vol. II (London: Archibald Constable, 1907), pp. 51–​62. 46 ‘Eum a coetu fratrum nostrorum segregatus ad quandam domum pauperum, ecclesie nostre conterminam … In xenodochium simili morbo laborantium segregatus est.’ William of Canterbury, ‘Vita, passio et miracula’, pp. 429–​30; W. Page (ed.), The Victoria History of the County of Somerset, Vol. II (London: Archibald Constable, 1911), pp.  141–​4. 47 Girard, Bouc émissaire, pp. 59–​60, 91. 48 Rawcliffe, Leprosy, p. 175. 49 ‘Et extendit Dominus paulatim per octo annos manum suam et tetigit eum, lepramque per totum corpus diffudit, et carnem ejus gravi ulcere vulneravit. Denique cum omnibus gravis et horribilis esset etiam ad videndum, non solum a militis domo, sed et a villa, matre sola illum, ne periret, sequente, expulsus est.’ Benedict of Peterborough, ‘Passio sancti Thomæ Cantuariensis’, in Robertson, Materials for the History of Thomas Becket, vol. II (London: Longman, 1876), p. 246. 50 W. Page (ed.), The Victoria History of the County of Sussex, Vol. 2 (London: Archibald Constable, 1907), pp. 56–​60. 51 ‘Godwinus quidam, famulus monachorum de Bosgrave, cum per biennium elephantiosus exstitisset, coelestem medicinam quaerere sollicitus fuit; et donec inveniret, nulla lassitudo, nullum taedium, nulla repulsa, petentem cohibuit.’ William of Canterbury, ‘Vita, passio et miracula’, p. 339. 52 2 Corinthians 12:9. 53 Hebrews 12:6. 54 The Letters of Lanfranc Archbishop of Canterbury, ed. and trans. H. Clover and M. Gibson (Oxford:  Clarendon Press, 1979), pp. 102–​3 (letter 21). 55 Touati, Maladie, p. 196; L. Buchet and I. Séguy, ‘La paléodémographie: Bilan et perspectives’, Annales de démographie historique, 2 (2002), 161–​212 (p. 175). 56 R. Brague, ‘L’anthropologie de l’humilité’, in R. Brague (ed.), Saint Bernard et la philosophie (Paris:  Presses universitaires de France, 1993), p. 138. 57 Saint Jerome, Commentariorum in Esaiam libri XII–​XVIII in Esaia parvula adbrevatio, ed. M. Adriaen (Turnhout:  Brepols, 1963), pp. 587–​8; Touati, Maladie, p. 188; Rawcliffe, Leprosy, p. 61.

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58 M.-​C. Sepière, L’image d’un Dieu souffrant: Aux origines du crucifix (IX e –​X e siècles) (Paris: Editions du Cerf, 1994), p. 223. 59 ‘What is, in fact, more beautiful than God and more deformed than a crucified man?’ Saint Augustine, Sermon XCV, 4, Patrologia latina (PL), 38, col. 583. 60 ‘Speciosus ille in gloria Jesus, quasi leprosus …’, in Scriptura domini Girberti abbatis de miraculo sanctae crucis, ed. F. Dolbeau, ‘Passion et résurrection du Christ, selon Gerbert, abbé de Saint-​ Wandrille († 1089)’, in M. W. Herren, C. J. McDonough and R. G. Arthur (eds), Latin Culture in the Eleventh Century, 2 vols (Turnhout:  Brepols, 2002), Vol. I, p. 243. 61 I have added the emphasis here. Ralph died on 19 January 1062. The Ecclesiastical History of Orderic Vitalis, ed. and trans. M. Chibnall, Vol. 2:  Books III and IV (Oxford:  Clarendon Press, 1969), pp. 29, 105. 62 ‘If any man has the desire to be first, he will be last of all and servant of all.’ Mark 9:35. N. Bériou, ‘Les lépreux sous le regard des prédicateurs d’après les collections des sermons Ad status du XIIIe siècle’, in N. Bériou and F.-​O. Touati, Voluntate Dei leprosus:  Les lépreux entre conversion et exclusion aux XIIe et XIIIe siècles, Testi, Studi, Strumenti, 4 (Spoleto: Centro italiano di studi sull’Alto Medioevo, 1991), pp. 33–​ 80 (p. 65). 63 ‘Infirmorum fratrum et clericorum cum eis Deo servientium ecclesia Sancti Egidii’. Rouen, Bibliothèque municipale (BM), MS 1232 (cartulary of Saint-​Gilles of Pont-​Audemer), fo. 4v (1152); M. Arnoux and C. Maneuvrier, ‘Deux abbayes de Basse-​Normandie: Notre-​Dame du Val et le Val Richer (xiie–​xiiie siècles)’, Le Pays Bas-​Normand, 1–​2 (237–​8) (2000), 48, no. 26c (c. 1160). 64 Matthew 20:28. 65 J. Dalarun, Gouverner, c’est servir:  Essai de démocratie médiévale (Paris: Alma, 2012), p. 135. 66 ‘Quanto abjectiores fiunt in seculo tanto proximiores efficiuntur Deo’. Rouen, BM, MS 1232, fo. 10v (1150). 67 Touati, Maladie, pp. 196–​7; Jeanne, ‘Lèpre humiliante’, pp. 305–​20; D. Jeanne, ‘Bénédiction ou malédiction? Maladies et malades sous le regard des bénédictins (XIe–​XIIe siècle)’, in P. Bauduin, G. Combalbert, A. Dubois, B. Garnier and C. Maneuvrier (eds), Sur les pas de Lanfranc, du Bec à Caen: Recueil d’études en hommage à Véronique Gazeau, Cahier des Annales de Normandie, no. 37 (Caen: Annales de Normandie, 2018), pp. 129–​37. 68 Touati, Maladie, pp. 191, 193, 195.

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69 Ibid., pp. 190, 229–​31, 703, 714, 729. 70 J. Derrida, ‘La pharmacie de Platon’, in J. Derrida (ed.), La dissémination, 3rd edn (Paris: Editions du Seuil, 1993), pp. 123–​4, 156. 71 E. Durkheim, Les formes élémentaires de la vie religieuse: Le système totémique en Australie, 6th edn (Paris: Presses universitaires de France, 2008), pp. 65, 427, 457, 588. 72 Rawcliffe, Leprosy, pp. 61–​3. 73 F. Chatillon, ‘Inter lepram et lepram discernere. (Jacques de Vitry, 30; F. Lettres, II, l.  122)’, Le Moyen Age latin, 21 (1965), 21–​ Chatillon, ‘Inter lepram et lepram discernere chez saint Bernard’, Le 20; Richard of Saint-​ Victor, De Moyen Age latin, 23 (1967), 117–​ XIII, in Opuscules théologiques, potestate ligandi et solvendi, XII–​ ed. J. Ribaillier (Paris: J. Vrin, 1967), pp. 93–​4. With skill, François-​ Olivier Touati used this dichotomy to dissociate representations from medical discourse: Touati, Maladie, pp. 81–​185. On Jacques of Vitry, see also C. Rawcliffe, Chapter 5 in this volume, pp. 96, 98. 74 Richard of Saint-​Victor, De potestate ligandi et solvendi, pp. 93–​4. 75 D. Jeanne, ‘ “Condempné et desclaré estre ladre”:  Simon Lecourt un “riche marchant tanneur” qui perd la face. Essai d’anthropologie historique sur le bouc émissaire’, in M. Hamon and A. Rovère (eds), Etre reconnu en son temps:  Personnalités et notables aux Temps modernes ([Paris]: CTHS, 2012), pp. 189–​202. 76 Girard, Des choses cachées, p. 544. 77 Leviticus 19:14. 78 Hugh of Saint-​Victor, Allegoriæ in Novum Testamentum, II, cap. XVI, PL 175, cols 790–​91, text cited by F. Bériac, Histoire des lépreux au Moyen Age:  Une société d’exclus (Paris:  Imago, 1988), p.  102 (misattributed to Richard of Saint-​Victor) and by Rawcliffe, Leprosy, p. 112. 79 Touati, Maladie, pp. 194–​5; Rawcliffe, Leprosy, p. 112. 80 Girard, La violence et le sacré, p. 460. 81 ‘Hic et enim jam poenam pro peccatis portantes ulterius puniri non habebunt pro quo dolores et cruciamenta carnis in suo corpore portaverunt.’ Rouen, BM, MS 1232, fo. 10v (charter of Hugh of Amiens, 1150). 82 See the 1321 ‘Lepers’ plot’, discussed in n. 28 above. 83 D. Jeanne, ‘Leprosy, lepers and leper-​houses: Between human law and God’s law (6th–​15th centuries)’, in S. Crawford and C. Lee (eds), Social Dimensions of Medieval Disease and Disability (Oxford: Archaeopress, 2014), pp. 69–​82.

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Part II

Within the leprosy hospital: between segregation and integration

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4 ‘A mighty force in the ranks of Christ’s army’: intercession and integration in the medieval English leper hospital Carole Rawcliffe The service which the Christian leper is pre-​eminently fitted for, is doubtless that of intercession. With heartfelt gratitude I  acknowledge help thus received on several occasions through the prayers of leper Christians, whose help I always invoke when on any special mission. Perhaps some day we shall wake up to the fact that within our Asylums is a marvellous latent force ready for use, longing for employment; and some child of God will arise to the occasion and organise a band of praying lepers who will … give themselves continually to definite prayer and thus become a mighty force in the ranks of Christ’s army.1

With these stirring words, delivered at a conference held in Calcutta in 1920, the Revd William C. Irvine sought to inspire the men and women who, like him, had devoted their lives to caring for sufferers from leprosy in the British colonies. He and his fellow missionaries were often prone to dramatise historical responses to the disease, contributing more than their fair share of myths and misinformation as they did so.2 But, in this instance, Irvine was voicing sentiments that seem more medieval than modern, and certainly in keeping with the beliefs of the countless individuals who founded and helped to maintain the 320 or so leprosaria established in England between the Norman Conquest and the Dissolution of the Monasteries.3 The motives of these benefactors reflect a complex combination of politics, the burgeoning of urban independence, concern for the sick, snobbery, fashions in piety and simple hubris.4 Yet, however worldly their other aspirations may have been, most of them nursed the devout expectation that the fires of purgatory would be doused

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and salvation more rapidly achieved through the prayers of grateful leprosi.5 The quest for spiritual health preoccupied senior clergy such as Bishop Richard Poore (d. 1237), whose grant of judicial protection to the leprous nuns of Maiden Bradley in 1228 evoked the poignant image of the diseased beggar, Lazarus, vainly seeking crumbs from the rich man’s table (Luke 16:19–​31). Whereas, in the New Testament parable, Dives, the personification of greed, was destined for the eternal torments of hell, a more hopeful fate surely awaited those who used their wealth to feed and house the sick. Lazarus’s entreaties may have failed to soften the heart of an implacable God, but there was an almost universal assumption that the prayers of his more fortunate successors would secure the redemption of patrons and well-​wishers. With a commendable display of humility as well as compassion, Poore compared himself to one of the dogs who had licked Lazarus’s sores, thereby bringing him a measure of comfort.6 Like many of the larger English leprosaria, Maiden Bradley followed a monastic (in this case Augustinian) rule, which, according to contemporary ideas regarding the tripartite division of society, automatically committed its residents to the task of praying for others rather than fighting or labouring.7 Unless they had already entered religion before contracting leprosy, or came from well-​ connected families, it was, nevertheless, unusual for patients in these institutions to be fully professed monks or nuns, even though they had taken the traditional vows of poverty, chastity and obedience. Instead, they occupied a constantly shifting position on the boundary between secular and religious life, being ranked by some canonists alongside the regular clergy, while others questioned their ability to cope with the demands and deprivations of the cloister.8 Tellingly, the influential preacher and theologian Jacques of Vitry (d. 1240) placed them in a separate category of their own, just below members of the military Orders, but first among all the various groups of laity, however prominent or influential.9 It might be assumed that only those lepers who wore some kind of habit would be deemed to be pursuing a religious vocation, but even quite small, less formal communities of diseased individuals assembled regularly for prayer, in part for their own benefit, but largely on behalf of past, present and future patrons.

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Much has already been written about the attractions of leprosi –​ or at least of those leprosi who comported themselves in a suitably pious and penitential fashion  –​as agents of redemption. They were, above all, regarded as living representatives of the tormented Christ, whose appearance quasi leprosus at the time of his Passion became an enduring theme in medieval art and literature.10 Assumptions about their special status were further encouraged by the longstanding belief that they belonged among the fortunate few, specifically designated by the Councils of Lyon (1274) and Florence (1438), who would be ‘purified’ of sin on earth through their physical suffering. As a result, they would ascend ‘straightway into heaven and have the pure vision of God himself’, bypassing purgatory altogether.11 Far less attention has, however, been paid to the ways in which these ideas may have influenced practical responses to leprosy, both before and after the Black Death, by which time attitudes towards the disease had grown more equivocal. This chapter will explore the intercessionary role undertaken by hospitalised leprosi and their priests, and the extent to which it fostered the social, as well as the spiritual, integration of those who were destined to live ‘outside the camp’. Adherence to a regimen of prayer was greatly facilitated by the availability of a church or chapel, which not only gave form and structure to the religious round but was also necessary for the celebration of Mass. Having noted the ubiquity of wayside chapels attached to suburban leper houses, and their importance to the healthy as well as the sick, we turn to the spiritual services offered there by men and women who were widely believed to constitute a type of monastic order in their own right. Yet funding was often precarious, and few leprosaria survived the demographic and social upheavals of the fourteenth century unscathed or, indeed, intact. A marked decline in the number of functioning institutions, coupled with growing concerns about environmental health, steadily undermined the idea of leprosy as a religious calling. Although they still sought to assist the sick and to enlist their prayers, from the 1340s onwards patrons were increasingly preoccupied with the sanitary imperatives that made segregation a more urgent priority than intercession. At the same time, other charitable enterprises, including public works, began to offer serious competition for financial support.

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Places of worship The provision of cemeteries and chapels in leprosaria, which was enshrined in canon law from 1179 onwards, was primarily intended to offer the solace of religion to men and women who were obliged by Mosaic Law to live apart from the healthy.12 Jacques of Vitry praised the efforts made by the new orders of hospitallers to minister the sacraments of confession, the Mass and extreme unction to the sick, whose spiritual welfare was further assured by the continuous celebration of the divine offices ‘night and day … in a common chapel’ so that all could hear as they lay in bed.13 Precept did not, of course, always accord with practice. When the lepers of West Somerton in Norfolk staged an open rebellion against their patron, the prior of Butley, in the 1290s, their long list of grievances highlighted his failure not only to maintain the fabric of their chapel, but also –​even worse –​to hire a reputable priest who could officiate for them on a regular basis.14 We cannot now tell how many English leprosaria possessed a chapel of their own, and thus by implication employed at least one priest on a full or part-​time basis. The suburban location of most houses poses a particular problem to archaeologists, since centuries of redevelopment have greatly curtailed the potential for even limited excavation.15 It is, however, clear from documentary sources that several late-​eleventh-​and early-​twelfth-​century foundations were well provided for from the outset.16 Some, including Saint Peter’s, Bury Saint Edmunds; Saint Laurence’s, Canterbury; and Saint Leonard’s, Clattercote, were established for the reception of leprous monks and clergy, who naturally wished to continue their customary devotions.17 Others, such as Saint Giles’s, Holborn (on the western approaches to London); the hospital of Saint Mary Magdalen at Dudston (near Gloucester); and Saint Giles’s, Shrewsbury, gave diseased laymen and -​women an opportunity fully to embrace the religious life.18 Seeking to embellish his account of the martyrdom of William of Norwich on Good Friday 1144, the monastic chronicler Thomas of Monmouth described the appearance of a shooting star over the boy’s murdered body in a wood outside the city. Among the many witnesses to this miraculous event was the widow of a Norman nobleman who had abandoned her earthly

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possessions so that she could tend the inmates of the nearby leper house at Sprowston. ‘But the sick people of that place in the same night as they were getting up for the midnight office in the silence of the night, when Legarda showed it them, [also] saw the brightness of that same light’, Thomas adds, confirming that they already by then observed a strict liturgical round in their handsome chapel.19 So too, apparently, did the inmates of Saint James’s, Chichester, whose revised regulations of 1408 drew attention to the fact that: In our hospital, from the time of its first foundation, as we believe,20 it was the custom that, about the first hour of the clock [‘circa primam horam de clok’] and after midnight [‘post mediam noctem’], a certain brother nominated by us as sacristan should arise every night, and should ring a certain bell to summon the brethren to say the appointed prayers before God [‘coram Deo’]. Once the bell has been rung, all the brethren should get up from their beds unless any of them is weighed down with grave illness or necessity and say, individually, standing up for the night office, a special commendation for the Catholic Church and the King and kingdom; and also for all benefactors of this hospital, living and dead, Credo in Deum once and the Lord’s Prayer a hundred times [‘centies’], with the salvatione of the Blessed Virgin, with a Credo at the end. And whatever is omitted at night is to be completed on the following day.21

From the 1180s onwards, the larger new leper houses naturally complied with Pope Alexander III’s recent ruling of 1179. Saint Giles’s, Maldon, for example, boasted ‘a sizeable leper church’ that was constructed shortly before the end of the century,22 while Bishop le Puiset’s lavish endowment of 1181 at Sherburn in County Durham aimed to provide the sixty-​five leprous inmates with the very finest spiritual as well as physical care. We might note, too, that the segregation of the sexes, so vital for the preservation of sanctity in a monastic space, even extended to arrangements for collective worship: First, the said Bishop Hugo laid down in the chapel of the said house, there be always three priests and four clerks to serve at the altars of God and St Mary Magdalene and St Nicholas; two of these are to serve at the altar of St Mary Magdalene on a weekly basis, one to celebrate the chanting appropriate to the season and the other the weekly offices for the faithful, time and time about; the third priest

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is to officiate at the altar of St Nicholas and always say mass for the dead, and this mass is also for the leper sisters below whose house, on the south side, the chapel is situated.23

During the early fourteenth century, Bishop Kellawe constructed a second chapel to the north of the first, where yet another priest was to ‘celebrate with solemnity a mass to the Blessed Virgin Mary … for the benefit both of the brothers too weak or ill to arise early and of the priests who, their own duties completed, will take part’.24 These developments ensured that the hospital became a liturgical showcase,25 although, as we shall see, the lepers were more than passive observers of the opus Dei, being expected to participate, as far as their health allowed, in an unending process of intercession for their fellow Christians, living and dead.26 Few English medieval leprosaria, or their patrons, could contemplate an investment on this scale. Nevertheless, even though many were too small, informal and transient to offer more than the most basic lodgings, some relatively obscure hospitals managed to acquire a chapel.27 When granting a plot of land to his otherwise poorly documented leper house at Seaford in Sussex, in 1172, Roger de Fraxineto proudly recorded that he had made an earlier award ‘on the same day that I caused their church to be consecrated by Hilary, Bishop of Chichester’.28 Since Roger had served as the king’s constable, he was presumably affluent enough to commission a new building.29 But it was always possible to utilise an existing one, such as the domestic chapel that Bath priory was given by Walter Hussey during the early twelfth century and subsequently earmarked as the ideal site for a leprosarium just outside the city.30 Similarly, when Hugh, earl of Chester, decided to found a leper house for the use of the residents of Coventry during the reign of Henry II, his choice of location at Spon in the western suburbs was determined by the fact that he already owned a chapel there.31 Elsewhere, efforts were made to replace modest original wooden structures, which had often developed organically in a rather haphazard fashion, with something more imposing and appropriate for Christian worship. At Saint Mary Magdalen, Winchester, timber gave way to stone during the second half of the twelfth century, as an aisled chapel and infirmary were constructed parallel to each other, perhaps in response to the papacy’s ruling of 1179.32 Even the patients themselves could contribute to a building fund. In

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1448, for example, Henry Wellys, who was then living in one of the ‘spytellhouses’ outside the Fyebridge gate of Norwich, left 6s 8d towards the construction of a new chapel for the benefit of his fellow leprosi, the old one being evidently deemed inadequate.33 The aim was not just to provide for the souls of the inmates, but to attract the support of affluent patrons who expected an increasingly comprehensive range of spiritual services, including intercessionary prayers and commemorative masses, in return for their largesse.34 Chapels, often resembling parish churches in both size and appearance,35 were, in short, an essential means of securing the legacies and donations without which most leprosaria found it difficult, if not impossible, to survive. Ecclesiastical concern about society’s obligations towards leprosi underscores the fact that, despite their physical separation from the outside world, they remained full and active members of the Christian Church. Because of the misleading emphasis on exclusion and segregation characteristic of so much literature on medieval leper houses, we tend to forget that they played an important part in the religious life of towns and cities. Indeed, some, such as Saint Giles’s, Holborn; Saint Leonard’s, Northampton; and Saint Nicholas’s, York, actually shared their chapels with local communities in need of a convenient place to worship.36 The imposing chapel of Saint James’s, Dunwich, with its fine Norman apse ‘not much unlike the antient form of the eastern churches’, likewise appears to have served the townspeople as well as the lepers.37 Although the royal leprosarium of the Holy Innocents, Lincoln, had its own chapel, staffed by two priests and a clerk, the ‘many and sufficient’ buildings in the precinct also included a parish church.38 Similarly, by 1220 a second, ‘public’ chapel stood next to the one lavishly endowed by the citizens of Exeter for the lepers of Saint Mary Magdalen.39 It would have been frequented by wayfarers as well as local people, since it occupied a prime position on the outskirts of the city. Most leper houses were deliberately sited next to busy suburban thoroughfares in order to attract donations from travellers who wished either to pray for a safe journey or to give thanks for one recently accomplished.40 The security of the alms boxes or chests so conspicuously displayed in the porches or naves of hospital chapels was a constant preoccupation of ecclesiastical inspectors,

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and reflects the importance of casual donations to the inmates, as well as the temptations posed to unscrupulous masters by such a readily accessible source of cash. Following one of several excoriating reports on the shortcomings of Saint Nicholas’s, York, the chancellor of England ruled in 1303 that henceforward the alms box in the church was to have three separate keys held by different people and, as a further precaution, might only be opened in public.41 Takings could be far from negligible, since many of the indulgences awarded to benefactors specifically required them to deliver their gifts in person. Bishop Seffrid’s late-​twelfth-​century confirmation of the foundation charter of Saint James’s, Chichester, for instance, promised that, because the hospital church was dedicated to Saint Mary Magdalen, ‘to whom much was forgiven because she loved much’, he would release ‘all shriven and penitent persons’ from a fortnight’s enjoined penance. They were, in return, to visit it on her feast day and assist the lepers.42 Concern about irregularities at the leprosarium of Saint James, Westminster, led in 1322 to the provision of a triple-​locked chest for the collection of alms offered under similar circumstances. With its rapidly shrinking complement of four priests, four healthy brothers and thirteen diseased sisters, all bound by oaths of poverty, chastity and obedience, the hospital was by this date experiencing an irreversible decline, which made it difficult to attract patrons. As we shall see, institutions that could no longer fulfil their initial mandate ‘for the glory and praise of God and the extension of his worship’ were among the first casualties in an increasingly competitive market.43

Saving souls The sale of spiritual services, often of a highly personalised nature, soon became a major source of revenue for those leprosaria that followed some sort of monastic or quasi-​monastic rule. It is now impossible to tell what proportion of houses may have done so, but there is certainly no lack of evidence regarding the special status accorded to cloistered lepers, notably during the later twelfth and early thirteenth century, when the Church was undergoing a period

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of regulation, systematisation and reform.44 Seeking guidance in 1209 with regard to the relaxation of the interdict imposed by Innocent III upon the whole of England, the dean and chapter of London asked if Innocent’s readiness to allow the celebration of a weekly Mass in conventual churches extended to hospitals where leper brothers (fratres leprosi) were living under a rule (regulariter vivant), with just one or two chaplains.45 As they may well have known, the Welsh laws of Hywel Dda already ranked the leper alongside ‘a cleric in holy orders or a religious’, while the theologian Robert of Flamborough, who was writing at this time, maintained that ‘not only monks and canons, but also templars, hospitallers and lepers in religious communities (leprosi qui sunt de congregationibus)’ should be classed as regulars.46 Whatever their precise canonical standing, the leper brothers and sisters in houses such as Saint James’s, Doncaster; Saint Giles’s, Holborn; Saint Mary’s, Maiden Bradley; and Saint Sepulchre, Hedon, were frequently described by benefactors as ‘Deo servientibus’, a form of address that recognised their dedication to a life of divine service.47 The physical appearance of these men and women further underscored their particular vocation, since most were expected to adopt some type of monastic habit, or at least to wear a sober monochrome uniform that distinguished them from less deserving recipients of public charity.48 A visitation report of 1291 on Saint Nicholas’s, York, criticised the reluctance of new, fee-​paying entrants to be tonsured and wear the robes specified in the regulations, not least because such unmistakeable evidence of falling standards deterred potential benefactors.49 Nomenclature as well as dress reflected the special role of these communities. It is hardly surprising that Henry I’s second queen, Adela of Louvain, should describe the leprosarium that she founded in about 1135 at Wilton as the church of Saint Giles, since its religious functions clearly took priority over all others.50 The hospital of Saint Julian was likewise established by Abbot Geoffrey of St Albans (d. 1146) as an ecclesia specifically for ‘the poor of Christ, namely lazars [pauperes Christi, videlicet lezeres]’.51 Regulations of c. 1200 compiled for the hospital of Saint Margaret and the Holy Sepulchre, Gloucester, reflect the same scale of values, not only referring to ‘the church and the convent of the same place [laglise e le covent de memes le lieu]’ but also noting that the

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community bore a particular responsibility ‘to pray for the living and for the dead [prier pur les vifs e pur les mors]’. As a result of this commitment, all its supporters, rich or poor, would reap the celestial benefits of the 300 or more Aves and Pater nosters intoned daily by each brother and sister from matins to vespers.52 Individual commemoration of the sort favoured by more affluent patrons was a matter for negotiation. Thomas Toli’s gift of rents to feed ‘the infirm folk of the said house’ and illuminate their church (thereby providing a type of spiritual nourishment) was, for example, made on the understanding that the patients and their priest would say special prayers on his behalf during Mass.53 The grant was dated 1230, just as de Toli was setting out on a potentially dangerous pilgrimage to Jerusalem, which casts an interesting light on the presumed efficacy of intercession by cloistered lepers. Further proof of the integration of leprosi into the spiritual world of the healthy comes in the shape of a slim, seemingly unremarkable leather-​ bound volume, measuring approximately 20  cm by 28  cm, which contains the mortilegium, or register of obits, of the leper hospital of Saint Mary Magdalen, Gaywood, to the north-​east of King’s Lynn.54 Allegedly founded in the mid-​ twelfth century, but probably later, the hospital housed both healthy and leprous brethren and sisters, whose rule obliged them to observe the canonical hours and to intercede personally for their benefactors every day at Mass.55 From about 1296 onwards, patrons and well-​wishers could also gain admittance to the house’s spiritual confraternity, thereby benefiting from whatever additional prayers and masses might be offered in perpetuity for members. The list of names, which was regularly updated, covers twenty-​seven folios of closely written double columns. It offers a fascinating insight into late medieval popular piety, not least because the poor calligraphy of the final entries, inscribed shortly before the doctrine of purgatory was formally abolished by English reformers in the 1540s, suggests that popular enthusiasm for the commemoration of the dead was already beginning to wane.56 The roster is headed by the names of successive kings of England from Stephen to Edward I and of the bishops of Norwich who had charge of the hospital during their reigns. It then solicits divine protection collectively for those at sea, for all the merchants of Lynn and their wives, and for the town’s bakers and brewers, who appear

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to have been the house’s chief benefactors.57 Prominent among the hundreds of named individuals were local clergy, some of whom ministered at the leprosarium. But the great majority were ordinary laymen and women from towns and villages scattered across Norfolk, the half dozen knights being heavily outnumbered by those who lacked even a surname. A few were evidently prompted to support the hospital because one of their relatives was, or had been, a priest or patient there, as in the case of Robert and Emma Glover of Wymondham and their three children, whose kinsman, ‘Dominus’ John Glover, served as a chaplain and later prior or master.58 William Myller and his sister Katherine, a leper ‘de domo infirmorum de Geywood’, likewise belonged to the confraternity, as, interestingly, did members of the Brouster family, even though one of them lay sick in another leper house at Walsingham, some twenty miles away.59 Understandably, in a society beset by plague, several of the men and women listed towards the end of the volume had already turned to the hospital before death, the invocation ‘pro vita et pro anima’ against their names being eventually truncated as they began their painful progress through the cleansing fires of purgatory, helped by the prayers of those who would apparently be spared this ordeal. Over the years, this remarkable assemblage of the quick and the dead, of clergy and laity, of rich and poor, of patrons and their clients, of townsmen and countrymen, of the leprous and the healthy, coalesced into a single community dedicated to the upkeep of Saint Mary’s and the welfare of the faithful departed. The activities and aspirations of medieval religious guilds have attracted a good deal of scholarly attention since the 1980s, largely because, in the words of Gabriel Le Bras, they constituted ‘artificial families’ that aimed ‘to satisfy the most poignant needs of the body and the soul’ far beyond the grave.60 Prominent among the many different types of organisation to provide such support were those specifically designed to permit secular clergy, laymen and -​women to draw upon the celestial credit accumulated by religious houses through a constant round of masses, prayers and other devotions. Despite the interest shown by historians in the development of monastic fraternities, parallel developments in leper houses and other charitable institutions have been largely ignored, even though they were far from unusual.61 Admittedly, leprosaria such as Saint Margaret’s, Taunton, could at first only offer their benefactors

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membership of the spiritual brotherhoods set up by neighbouring monasteries, which were clearly anxious to retain their monopoly in this lucrative trade.62 Before long, however, they were running confraternities of their own. Donors to the hospital of Saint Mary Magdalen, Liskeard, enjoyed the best of both worlds, being promised in 1326 a share in all the spiritual merits accrued by the brothers and sisters, as well as by nine monastic houses scattered across Devon and Cornwall. They could also expect a grand total of fourteen years’ and 400 days’ remission of penance, secured through the many papal and episcopal indulgences allegedly awarded to the hospital.63 These letters of confraternity bear all the hallmarks of a ‘pious fraud’, designed to raise much-​needed capital by exploiting widespread fears about the torments to come and anxiety about the best means of avoiding them. As reformers were later to complain, flagrant profiteering and even deceit were bound to flourish once hard-​pressed institutions began to market their spiritual services on a commercial basis.64 The books employed to record the names of donors were generally ‘small, thin and handy volumes’, being designed to sit easily on the altar at the right hand of the celebrant during the Canon of the Mass, when prayers would be said either collectively or individually for the men and women listed within by priest and congregation.65 Since they were rarely illuminated or otherwise embellished, mortilegia had little material value to collectors, while at the same time ranking high on the list of heretical works destined for the bonfire or rubbish heap during the mid-​sixteenth century. To compound the problem, some had already vanished long before then, partly through the negligence and maladministration that afflicted so many English hospitals.66 We do, however, know from stray references in other sources that several liturgically active leprosaria were careful to record the names of leading benefactors. For example, a visitation of the above-​mentioned leper house at Sprowston, in 1368, listed an impressive provision of vestments, plate and service books, including a mortilegium  –​all of which appear to have been destroyed in the 1530s.67 One belonging to the hospital of Saint John at Thetford may have been seen by the Norfolk antiquary Francis Blomefield (d. 1752), who claimed that its fraternity flourished until the Dissolution and recruited many members.68 We know, too, that the patrons of Saint James’s,

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Doncaster; of the leprous nuns at Maiden Bradley; of the Harbledown leprosarium near Canterbury; and of Saint Bartholomew’s, Dover were commemorated in their respective mortilegia.69 Saint Bartholomew’s was an Augustinian house, whose inmates had to undertake an unusually heavy round of suffrages, described in detail in the cartulary of 1372. The oath sworn by new brothers and sisters that they would conscientiously intercede for their benefactors (‘specialiter pro omnibus benefactoribus’) was no empty formality. In theory, at least, there can have been little time for other activities, since all but the moribund had to complete their daily schedule of prayers (comprising 400 Aves and the same number of Pater nosters) while seated upright in bed at midnight (‘in medio noctis’).70 The quality of such offerings mattered as much as, if not more than, the number that might be rattled off at any given time, and could prove contentious. Clearly shocked by the ignorance of some of the inmates, the ecclesiastical inspectors who visited Harbledown in 1299 recommended that all future applicants to Saint Nicholas’s should be examined on the Pater Noster, Salve Regina, Ave and Creed before admission, in order to establish that they were ‘sufficiently instructed’ and could ‘say the same clearly’. Because poor diction and limited understanding seemed to encourage laxity, they decreed that anyone who failed to discharge his quotidian burden of prayers in future would have to recite twice as many before the assembled chapter. The threat of public humiliation seemed more effective than that of the physical punishments, including reduced rations and the rod, employed elsewhere.71 Given the debilitating effects of leprosy on the human voice, we must assume that due allowance was made for those who could barely speak. It must, nonetheless, have been tempting to select the strongest and most tractable candidates, especially in a house that guaranteed all its benefactors a spectacular 4,000 prayers said every day by the resident staff and patients, as well as the combined benefits of no fewer than fifty-​three indulgences.72 How the leprosi themselves reacted to these demands is unknown, although some understandably found them irksome and proved reluctant converts. As Jennifer Stemmle points out, the desire for care and membership of a protective community must often have outweighed any sense of vocation, especially in a world that could be far less tolerant of disfiguring disease than some theologians

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might have wished.73 Significantly, the hospital and chapel built at Boughton under Blean (also near Canterbury) by Thomas atte Herst shortly before 1384  ‘for lepers and other infirm persons thither resorting’ admitted ‘a certain number of lay brethren and sisters’ whose specific task was to pray for the king.74 The leprosi may have been too few in number, too sick, too ignorant or simply too intransigent for such a task.

Changing attitudes François-​Olivier Touati has detected a marked change in attitude to cloistered lepers during the thirteenth century, as responses to the disease became increasingly ambivalent and judgemental. Having been previously regarded as places for the pursuit of a religious vocation or ‘itinéraire de conversion’, where men and women might voluntarily embrace the monastic life, continental leprosaria were, he believes, gradually transformed into penitential institutions for the containment of individuals whose moral status seemed at best equivocal.75 A similar phenomenon is apparent in England, although it occurred somewhat later and was generally less overt. Even so, as the threat of mors improvisa gripped the national psyche during ‘the golden age of bacteria’ that followed the Black Death of 1348–​50,76 the attractions of lepers as intercessors grew less compelling, and, with a few local exceptions, lost much of their initial appeal. This was partly due to basic demographics, since the sick appear to have succumbed heavily both to plague and to the successive famines that had already taken a heavy toll on the more vulnerable members of society.77 At the same time, improved standards of diagnosis, based on widely available vernacular medical texts, meant that verdicts became more cautious, while those who faced physical segregation did not necessarily wish to embrace an institutional life –​or, indeed, appear suitable for it.78 Other factors, too, account for the dramatic decline in the number of functioning leprosaria from the 1300s onwards. Even the largest and hitherto most affluent English hospitals encountered serious problems during the challenging years of the fourteenth century, when acute financial difficulties were often compounded by poor, sometimes venal management.79 Leper houses, whose funding was

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frequently precarious, tended to sustain the heaviest casualties. The leprosarium allegedly founded by Archbishop Thurstan of York (d. 1140)  for the blind priests and lepers of Ripon had virtually abandoned its charitable activities by 1341, although it is unclear from an inquisition held at that time if the lack of patients was a cause or a result of the demolition of the quarters once reserved for leprosi. Earlier inventories of the chapel, which possessed a fine crystal reliquary containing a fragment of bone said to belong to its patron saint, Mary Magdalen, as well as an impressive haul of books and vestments, suggest that liturgical provision must once have been of the highest order.80 By the 1430s, even Bishop le Puiset’s imposing foundation at Sherburn was in crisis, being then transformed into a chantry chapel with an adjoining almshouse for thirteen paupers. As a telling memorial to its initial function, Thomas Langley, then bishop of Durham, decreed that two lepers should be supported there ‘if so many can be found, or they will come there freely and wish to stay (si in partibus reperiri poterint aut sponte illuc accesserint et ibidem morari voluerint)’.81 As a result of these developments, empty beds originally intended for lepers were increasingly occupied by the elderly or disabled, especially if they could afford to contribute towards their upkeep. We can document the early stages of such a transition at the civic leper house of Saint Mary Magdalen, Exeter, where the blind and aged had been offering goods and property in return for places from at least the 1250s.82 It was far from unusual for hospitals to house lepers alongside other patients, but in some instances the shift to what might anachronistically be termed ‘privatisation’ caused friction with local communities. Urban authorities expected these institutions to fulfil their initial purpose by providing free care for the needy, particularly when infected residents had to be removed from the streets. The above-​mentioned inquiry of 1291 into abuses at Saint Nicholas’s hospital, York, found that the customary practice of admitting lepers, together with ‘the old and feeble of the city’, without charge had been abandoned. Preference was instead being accorded to men and women who could pay entry fees of up to £15, irrespective of their condition. Even worse from the perspective of future benefactors, rampant commercialism was accompanied by an alarming neglect of the opus Dei, since these affluent newcomers felt no obligation to offer intercessionary prayers on behalf of

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others.83 Similar complaints were voiced independently by the royal commissions that inspected the hospital of the Holy Innocents, Lincoln, in 1316,84 and Saint Laurence’s, Bristol, sixty years later, it being noted on the latter occasion that the principal casualties of malfeasance were ‘divine worship’ and ‘works of piety’.85 New ordinances compiled in 1423 for the leper hospital of Saint Mary Magdalen, Colchester, are notable for their insistence that priority should first be given to lepers, but otherwise to the ‘infirm’ poor. All were, significantly, to be admitted without any charge, on the clear understanding that they would follow a strict daily round, comprising the seven canonical hours, Mass and the recitation of 300 Pater nosters for the health of their patrons.86 Besides having to compete with other types of hospital for donations, from the thirteenth century onwards leper houses faced the additional challenge posed by the new mendicant orders, whose urban mission attracted generous support from wealthy philanthropists.87 Changing fashions in piety meant that potential donors were also drawn to more exciting and novel projects, including public works, such as piped water and street paving, and the foundation of almshouses, whose respectable elderly inmates were harnessed to a treadmill of prayer and religious observance modelled on that previously to be found in the larger leprosaria.88 And although some lepers, at least, were still regarded as the elect of God, whose sufferings on earth made them powerful advocates for the salvation of others, few could escape the growing unease occasioned by developments in the understanding of environmental health. The dissemination of medical texts from Muslim centres of learning, of which the Canon of Avicenna proved by far the most significant, not only transformed approaches to diagnosis but also introduced western readers to more sophisticated concepts of infection.89 Concerns about the transmission of leprosy on the breath, because of sexual activity, or through the gaze or touch of its victims, were rarely voiced in England before the mid-​thirteenth century, there being little evidence that people had previously worried about catching the disease from others. Signs of a dawning awareness of the presumed threat posed by leprosi may be found in an award of 1276 made by Archbishop Robert Kilwardby to Saint Nicholas’s, Harbledown, which was by then experiencing such a

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decline in ‘charitable contributions’ that it could no longer afford to employ a resident priest. Highlighting what seemed a predominantly physical rather than a spiritual problem, he observed that ‘in the said hospital a hundred lepers are confined to avoid contagion’, and expressed concern that, without a minister of religion to serve them, they might disperse into the wider community.90 The medical rationale for segregation is even more apparent in a similar argument advanced seventy years later by Ralph Stratford, bishop of London, who stressed the importance of allowing the lepers at Saint Mary’s hospital, Ilford, constant access to the sacraments. It was essential to deprive them of any legitimate excuse for leaving the precinct, he warned, since they posed such a risk to healthy people (‘cum ipsorum conversatio sanis periculosa existat’).91 From the first outbreak of plague onwards, fears of infection spread by contaminated air meant that towns and cities regarded the provision of leprosaria as a matter of self-​preservation as well as Christian compassion. In 1402, for instance, the rulers of Beverley sanctioned the construction of new lodgings just outside the North Bar for the reception of leprous men and women. Although this refuge evidently fell out of use at some point before the end of the century, it was rebuilt again for lepers (or perhaps victims of the pox) in 1494.92 The rulers of London, which experienced an alarming number of epidemics during the later Middle Ages, were understandably exercised by the lack of suitable accommodation for leprosi. Their ongoing and often acrimonious dispute with the Order of Saint Lazarus over the patronage and management of the royal leprosarium of Saint Giles, Holborn, came to a head in 1354, just five years after the Black Death. Protesting that the Order had squandered resources worth over £100 donated by Londoners ‘for the maintenance of lepers in the hospital of Saint Giles, for lepers only’, and no longer admitted the sick, ‘contrary to the will of the donors aforesaid and to the great danger of healthy persons’, the mayor and aldermen forced the master to support fourteen ‘poor diseased folk’ from among the citizenry free of charge.93 Significantly, persistent complaints about the chronic misappropriation of hospital resources also focused upon ‘the diminution of divine worship and works of piety established of old time to be done there’, as the Londoners sought to safeguard the commemorative prayers and masses for which their ancestors had

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paid so handsomely.94 The wishes of men such as Henry FitzAlwyn (d. 1211), the first mayor of London, who had bequeathed an annual rent of 5s for an anniversary service on the day of his death, and Robert FitzAlice, who had provided the brothers and sisters with pittances worth 4s a year in return for a similar obit, were being ignored, to the prejudice of their immortal souls.95 We can readily appreciate why the civic elite chose to endow two new leprosaria, in Hackney and Southwark, which were placed under the direct management of elected lay officers. Indeed, by 1417 the latter had also assumed responsibility for overseeing the welfare of the lepers at Saint Giles’s and ensuring that the master kept his word.96 The continuing level of popular support apparent from the mortilegium of Saint Mary’s, Gaywood, had much to do with the fact that leprosy remained endemic in nearby King’s Lynn. In her spiritual autobiography, composed during the early fifteenth century, the celebrated local mystic Margery Kempe claimed to have experienced ‘gret mornyng & sorwyng for sche myth not kyssyn the lazerys whan sche sey hem er met wyth hem in the stretys for the lofe of Ihesu’.97 Such encounters may have become less common, for at this time the rulers of Lynn were intensifying their efforts to remove any suspects to extramural locations. Having demolished at least one of their four leprosaria in 1331–​32, presumably for lack of patients, they found it necessary to establish three new houses during the course of the later fourteenth century.98 This was partly because, from at least 1375 onwards, they had begun to employ panels of ‘discreet persons’ with sufficient knowledge to make an accurate diagnosis and insist upon segregation, thus highlighting the need for institutional care.99 Margery’s odyssey took her either to one of these suburban houses or to Gaywood, ‘wher seke women dwellyd, whech wer ryth ful of the sekenes’. There she ‘fel down on hir kneys be-​forn hem, preyng hem that sche myth kyssyn her mowth for the lofe of Ihesu … with many an holy thowt & many a deuowt teer’.100 The traditional association between suffering lepers and ‘owr Lord Ihesu Crist wyth hys wowndys bledyng’ had by then received renewed impetus through the revelations of Saint Bridget of Sweden.101 Her Liber celestis of 1376, which circulated widely in English translation and had a formative influence upon Margery’s own brand of personal piety, describes the crucified Christ with remarkable clinical accuracy as ‘leprous and bloo’, his face ‘drawen

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togidir and contracted’ and his hands ‘so starke thai might noght be put forthir than aboute the navil’.102 Intense popular devotion to Christ’s macerated body ensured that lepers retained some of their special status. Although few of Margery’s contemporaries sought to follow her example, they still remembered local leprosaria in their wills, generally prioritising those under lay management.103 A  widespread belief in the prophylactic effect of charitable works undertaken during epidemics may well have lent greater urgency to their endeavours. As late as 1485, Thomas Le Forestier began his vernacular treatise against ‘the venymous feuer of pestilens’ with the customary admonition that there was little point in resorting to earthly medicine without first devoting oneself to prayer and almsgiving.104 Few of his readers would have needed this reminder. Shortly after the second national plague outbreak of 1361 had cut a swath through the town’s youngest inhabitants, the people of Lynn erected a handsome marble cross just outside Saint Mary’s, Gaywood, which, like many leprosaria, lay on a boundary.105 Both boundary crosses and hospitals figured prominently in the religious processions staged by late medieval urban communities on feasts such as rogation tide and Corpus Christi. The elaborate public rituals employed in cities such as Canterbury, Coventry, Grimsby, Norwich and York increasingly served an apotropaic function to protect the populace from the ravages of epidemic disease, and it is tempting to assume that leprosi and their chaplains would have been enlisted as shock troops in the ongoing battle.106 But however devoutly they may have prayed, far fewer of them now followed a religious rule. The move away from management by monastic communities to secular control constitutes a defining feature of the late medieval English hospital, further undermining the belief that leprosy constituted a vocation, at least in the strict ecclesiastical sense. New foundations were generally endowed by laymen, such as the Cambridge burgess Henry Tangmere, who established the leper house of Saints Anthony and Eligius just outside the Trumpington gate in the 1360s (again following the second outbreak of plague).107 Before too long, the mayor and bailiffs had taken charge of routine administration, appointing the wardens and overseeing the production of proper accounts. A detailed inventory of possessions compiled in 1526 reveals the close level of supervision exercised by

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the authorities, as well as the generosity of those who had enriched the hospital chapel with images, vestments, altar cloths, service books and plate, in the hope that the prayers that they inspired would tip Saint Michael’s scales at the Last Judgement. Some donors, such as John Green, who presented a frontal for the altar painted with the images of the patron saints, clearly intended that their gifts would serve as an aide mémoire for the commemoration of their names during Mass.108 Green’s gift highlights a further shift in the priorities of benefactors and suggests that the late medieval focus upon Christ’s Passion may sometimes have proved less helpful to his earthly representatives than at first appears. As we have seen, the Mass had always played a vital role in hospital life, but a growing emphasis from the early thirteenth century onwards upon its redemptive powers meant that it came to assume particular importance in the eyes of donors.109 Despite the substantial sums of money involved, setting up a chantry where Mass could be regularly said or sung on behalf of named individuals did not generally require the active participation of anyone other than a suitable priest or priests. When arranging in 1256 for the provosts of Bridport, Dorset, to supervise the local leper house, which he had just endowed, Sir William de Leigh was understandably anxious that the patients should be well treated. Yet his overwhelming concern was for the daily celebration of commemorative masses by the two chaplains ‘of laudable life and honest conversation’, upon whom his speedy passage through purgatory so obviously depended.110 On the assumption that hospitals, as religious institutions, could be relied upon to offer a reassuring degree of permanence in an uncertain world, private chantries of this type became even more popular once plague epidemics began to occur at frequent and devastating intervals. Such confidence could, however, be misplaced. The irritation so frequently expressed about absenteeism on the part of hospital masters arose not only from their administrative shortcomings but also because of their failure to celebrate Mass as often as patrons expected, if at all.111 The centrality of the Eucharist helps to explain why so many leper houses continued to function as chantry chapels long after all, or most, of the inmates had left, since this aspect of their role had come to dominate all others.112 Its importance is strikingly apparent

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in a contract of 1521 made between the mayor and burgesses of Nottingham and the chaplain newly appointed as master of Saint Leonard’s hospital. Due emphasis was given to ‘sustaining and housing the lepers born of the liberty of the town’ (‘sustentando et hospitando leprosos de libertate villae Nottingham’ natos’), but the greater part of the document comprises a minute rehearsal of the liturgical duties through which the priest alone would safeguard the  spiritual health of the townspeople. Significantly, he was to celebrate Mass elsewhere, in Saint Mary’s Church, rather than among the patients.113 We should not, however, assume that the spiritual currency of England’s fast-​declining ‘band of praying lepers’ had lost all its value. Notwithstanding the patently implausible claims made on behalf of Bridport’s leprosarium (which boasted ‘an antiquity to rival Joseph of Arimathea at Glastonbury’), people were far readier to purchase its indulgences than others being sold in support of more prestigious or apparently ‘useful’ local projects.114 In 1448, the proctor appointed to raise money in Kent and Essex for harbour works in Bridport apologised profusely to the authorities for his dismal takings: I may not gaderyn good here, lyk as I  dede this last yer and other yeris in myn other occupacioun of Marie Magdalene [as agent for the leper house]. In that occupacioun, I cowde gaderyne of sum men grotis … and pens and flesis [fleeces] of wolle, and broke silvire and ryngges, more in a day that tyme than now I can in viij dayes; and now I am fayne to gaderyn at an hows a dyschful of whete or malt or barly, or a pece bacon … and so am wery of myn offys, but [unless] it wolde amende.115

Nor should we dismiss the Bridport lepers and their peers as little more than a ‘liturgical appendage’, whose token presence merely served to advertise the largesse of their benefactors.116 In theological terms, at least, their intercessionary activities still represented a notable act of Christian compassion, which further increased the reserves upon which others might draw. According to that bastion of traditional religion Sir Thomas More, writing on the eve of the Dissolution, the recitation of prayers for the dead ranked as a work of outstanding merit, far greater than any act of philanthropy undertaken for the living. As he explained in The Supplication of Souls:

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Of all kynd of almoyse [alms] that eny men can geue, the moste merytoryouse ys that which ys bystowed vppon vs [the dead], as well for that yt ys vnto the moste nedy and also to them that are absent; and fynally for that of all maner almoyse yt is moste grownded vppon the foundacyon of all crysten vertuose fayth. For as to pore folke, a naturall man wyll gyue almoyse eyther for pytye of some pytuose syght, or for werynesse of theyre importune cryenge. But as for vs pore sowlys passed the world, whome he that gyueth almoyse neyther seeth nor hereth:  wolde neuer bestowe one peny vppon vs but yf he had a fayth that we lyue styll, and that he fered that we lye in payne, and hopyd of hys reward in heuen. Whych kynde of fayth and good hope ioyned [combined] wyth his gyft and good wurck, must nedys make it one of the best kynd of almoyse dede that eny man can do in the world.117

Conclusion In the last resort, whatever problems may have beset the inmates of English leprosaria, they remained closely woven into the fabric of a society whose concerns in this life reflected a sense of terror regarding the tribulations to come. This anxiety found concrete expression throughout post-​Conquest England in the endowment of monasteries and of hospitals where cloistered lepers might follow a religious rule, interceding, like monks and nuns, for the salvation of their benefactors. Their privileged status inevitably declined as the focus of popular piety changed; as the number of confirmed lepers began to fall; and, crucially, as fear of contagion took hold from the late thirteenth century onwards. Yet, even after the onset of plague intensified these fears, the parable of Dives and Lazarus continued to exert a powerful hold over the late medieval imagination.

Notes 1 I would like to thank Dr Elma Brenner and the late Peter Martin for their helpful comments on earlier drafts of this chapter. 1 W. C. Irvine, ‘Christian teaching and spiritual work in asylums’, in Report of a Conference of Leper Asylum Superintendents and Others on the Leper Problem in India (Calcutta: Orissa Mission Press, 1920), p. 134.

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2 Rawcliffe, Leprosy, pp. 29–​39. 3 A gazetteer of leprosaria may be found in A.  E. M.  Satchell, ‘The emergence of leper-​houses in medieval England, 1100–​1250’, D.Phil. dissertation (University of Oxford, 1998), pp. 250–​399. For addenda and a map showing their distribution, see Rawcliffe, Leprosy, pp. 106–​7. 4 As Bernard Mandeville observed, ‘pride and vanity have built more hospitals than all the virtues together’: The Fable of the Bees, ed. F. B. Kaye, 2 vols (Oxford:  Clarendon Press, 2001), Vol. I, ‘An essay on charity and charity-​schools’, p.  261. For the economic, political and social integration of leper hospitals into English medieval urban life, see C. Rawcliffe, ‘¿“Fuera del campament”? Leproserias urbanas en la Inglaterra medieval’, in T. Huguet-​ Termes, P.  Verdés-​ Pijuan, J. Arrizabalaga and M. Sánchez-​Martínez (eds), Ciudad y hospital en el Occidente europeo, 1300–​1700 (Lleida:  Editorial Milenio, 2014), pp. 95–​114. 5 The word ‘leper’ carries a unique stigma in modern society and is rightly to be avoided in discussions of what is now known as Hansen’s disease. Its use in a medieval context, when diagnosis was less secure, and attitudes were very different, is explained at length in Rawcliffe, Leprosy, pp. 11–​12. 6 English Episcopal Acta, 19, Salisbury 1217–​1228, ed. B. R. Kemp (Oxford: Oxford University Press, 2000), no. 319. 7 Medieval society was traditionally divided along these lines:  P. E. Dutton, ‘Illvstre civitatis et popvli exemplvm:  Plato’s Timaevs and the transmission from Calcidius to the end of the twelfth century of a tripartite scheme of society’, Mediaeval Studies, 45 (1983), 79–​119. 8 J. Avril, ‘Le IIIe Concile du Latran et les communautés de lépreux’, Revue Mabillon, 60 (1981), 21–​76 (pp. 63–​5); Touati, Maladie, p. 688. 9 N. Bériou, ‘Les lépreux sous le regard des prédicateurs d’après les collections de sermons ad status du XIIIe siècle’, in N. Bériou and F.-​O. Touati (eds), Voluntate Dei leprosus: Les lépreux entre conversion et exclusion aux XIIème et XIIIème siècles, Testi, Studi, Strumenti, 4 (Spoleto: Centro italiano di studi sull’Alto medioevo, 1991), pp. 33–​80 (pp. 38–​40). 10 Rawcliffe, Leprosy, pp. 60–​4, 142–​6,  197–​8. 11 G. Marc’hadour, ‘Supplication of souls’, in The Complete Works of St Thomas More, Vol. VII, ed. F. Manley, G. Marc’hadour, R. Marius and C.  H. Miller (New Haven, CT:  Yale University Press, 1900), pp. xcii–​xciii. 12 Decrees of the Ecumenical Councils, ed. and trans. N. P. Tanner, 2 vols (London:  Sheed & Ward; Washington, DC:  Georgetown University Press, 1990), Vol. I, pp. 222–​3; Avril, ‘Le IIIe Concile du Latran’,

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pp. 25–​34. For a reassessment of this provision and its confirmation of ‘the Christian personhood of those with leprosy’, see S. Watson, On Hospitals: Welfare, Law and Charity in Western Europe (Oxford: Oxford University Press, 2020), pp. 41–7. 13 The ‘Historia occidentalis’ of Jacques de Vitry, ed. J. F. Hinnebusch (Fribourg:  Fribourg University Press, 1972), p.  147; J. Bird, ‘Translation of Jacques de Vitry, Historia occidentalis, 29, and edition of Jacques de Vitry’s sermons to Hospitallers’, in P. Biller and J. Ziegler (eds), Religion and Medicine in the Middle Ages (Woodbridge: York Medieval Press, 2001), pp. 109–​34 (p. 110). 14 Not surprisingly, the prior contested these allegations, although he was ordered to rebuild the chapel:  London, BL, Harley Roll N 20; R. Mortimer, ‘The Prior of Butley and the lepers of West Somerton’, Bulletin of the Institute of Historical Research, 53 (1980), 99–​103. 15 S. Roffey, ‘Medieval leper hospitals in England:  An archaeological perspective’, Medieval Archaeology, 56 (2012), 203–33 (213–16, 223–5)​​. For a valuable analysis of such evidence as does survive, see M. Huggon, ‘The Archaeology of the Medieval Hospitals of England and Wales, 1066–​1546’, Ph.D.  dissertation (University of Sheffield, 2018), Chapter 4. 16 Sheila Sweetinburgh notes that most of the leper houses founded in Kent before 1179 boasted a chapel:  The Role of the Hospital in Medieval England:  Gift-​ Giving and the Spiritual Economy (Dublin: Four Courts Press, 2004), p. 81. That of St Bartholomew’s, Rochester, was, for example, completed by 1124, a significant part of the Norman fabric still being visible today despite later rebuilding and restoration:  E. J. Greenwood, The Hospital of St Bartholomew, Rochester (Rochester: Staples Printers, 1962), pp. 13, 25–​30. 17 Charters of the Medieval Hospitals of Bury St Edmunds, ed. C. Harper-​ Bill, Suffolk Charters, 14 (Woodbridge:  Suffolk Records Society, 1994), pp. 6–​7; W. Somner, The Antiquities of Canterbury (London: R. Knaplock, 1703), pp. 38–​40; B. Golding, Gilbert of Sempringham and the Gilbertine Order c. 1130–​c. 1300 (Oxford: Clarendon Press, 1995), pp. 235–​9. 18 Satchell, ‘Emergence of leper-​houses’, p. 164 (Holborn); E. J. Kealey, Medieval Medicus:  A Social History of Anglo-​ Norman Medicine (Baltimore:  Johns Hopkins University Press, 1981), pp. 108–​ 9 (Dudston); A. T. Gaydon (ed.), Victoria History of the County of Shropshire, Vol. II (Oxford:  University of London, Institute of Historical Research, 1973), p. 106 (Shrewsbury). 19 Thomas of Monmouth, The Life and Miracles of William of Norwich, ed. A. Jessopp and M. R. James (Cambridge:  Cambridge University Press, 1896), p.  31. The hospital was allegedly founded by Herbert

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de Losinga (d. 1119), the first bishop of Norwich, and was run by the Benedictine monks of Norwich Cathedral priory:  C. Rawcliffe, The Hospitals of Medieval Norwich, Studies in East Anglian History, 2 (Norwich: Norwich Centre of East Anglian Studies, 1995), pp. 41–​7. 20 It was common for documents of this kind to emphasise that religious rituals had been ‘ordained of old’ in order to establish a sense of continuity, as we can see from Bishop Stratford’s revised rules of 1346 for the leper hospital of Saint Mary the Virgin, Ilford: Rawcliffe, Leprosy, p. 153. 21 London, BL, Additional MS 24828, fo. 143v (a nineteenth-​century copy of the lost original). An unreferenced translation of these statutes may be found in J. Magilton, F. Lee and A. Boylson (eds), ‘Lepers outside the Gate’:  Excavations at the Cemetery of the Hospital of St James and St Mary Magdalene, Chichester, 1986–​87 and 1993, Research Report, 158 (York: Council for British Archaeology, 2008), Appendix 2, pp. 155–​6. By the early fifteenth century the hospital, which claimed Henry I’s first queen, Matilda (d. 1118), as its founder, described itself as a ‘poor house’, or refuge for the indigent, although a will of 1418 left money to the lepers living there (p. 159). 22 J. Sayers, ‘The earliest original letter of Pope Innocent III for an English recipient’, Bulletin of the Institute of Historical Research, 49 (1976), 132–​5 (p. 134). 23 P. Richards, The Medieval Leper and His Northern Heirs (Woodbridge:  D. S.  Brewer, 2000), Appendix 2, p.  125. Alarmed by the scandal arising from the close proximity of men and women at the monastic leper hospital of Saint Julian, Abbot Warin of St Albans decided in 1194 to go even further by establishing a separate hospital with its own church for the sisters ‘ne amplius detestabilibus excessibus, quibus ante diffamabantur, viri et mulieres in saeculo commacularentur’: Gesta abbatum monasterii Sancti Albani, ed. H. T. Riley, 3 vols, Rolls Series, 28 (London: Longmans, Green, 1867–​69), Vol. I, pp. 201–​4. On the segregation of the sexes within leprosaria, also see E. Brenner, Chapter 6 in this volume, p. 172. 24 Richards, Medieval Leper, Appendix II, p. 125. 25 The bequests of plate, vestments and service books made to the Sherburn leper hospital in 1259 by Martin of Saint Cross, a former master, reflect the high standards then maintained: Wills and Inventories, ed. J. Raine, Surtees Society, 2 (London: Surtees Society, 1835), pp. 6–​11. 26 For the wider theological context in which the demand for intercession increased, see E. Duffy, The Stripping of the Altars: Traditional Religion in England 1400–​1580 (New Haven, CT: Yale University Press, 1992), Chapter 10; and C. Burgess, ‘ “A fond thing vainly invented”: An essay on purgatory and pious motive in later medieval England’, in S. Wright

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(ed.), Parish, Church and People: Local Studies in Lay Religion 1350–​ 1750 (London: Hutchinson, 1988), pp. 56–​84. 27 As, for example, Saint Leonard’s, Aylesbury, which had no known founder or patron, being totally dependent upon small grants of land from local people and casual alms:  Satchell, ‘Emergence of Leper-​ Houses’, pp.  196–​201. Considerable effort may initially have been expended in embellishing these places, on the assumption that they would continue to attract ad hoc donations. Both the nave and the chapel of the early-​thirteenth-​century chapel at the leper hospital of Saints Margaret and Anthony, Wimborne, were adorned with wall-​ paintings, even though the house lacked a ‘sufficient endowment’ to survive without assistance:  W. Page (ed.), Victoria History of the County of Dorset (London: University of London, Institute of Historical Research, 1908), pp. 106–​7; An Inventory of the Historical Monuments of the County of Dorset, Vol. V, East Dorset (London: HMSO, 1975), pp.  44–​5. 28 M. A. Lower, ‘The hospital of lepers at Seaford’, Sussex Archaeological Collections, 12 (1860), 112–16 (115). 29 W. Page (ed.), Victoria History of the County of Sussex, Vol. II (London:  University of London, Institute of Historical Research, 1907), p. 105. Following the royal example, other members of Henry II’s household, including his steward, Manasser Bisset, endowed mentioned house for leprous leprosaria, in this instance the above-​ nuns at Maiden Bradley: B. Kemp, ‘Maiden Bradley Priory, Wiltshire, and Kidderminster Church, Worcester’, in M. Barber, P. McNulty and P. Noble (eds), East Anglian and Other Studies Presented to Barbara Dodwell, Reading Medieval Studies, 11 (Reading: Graduate Centre for Medieval Studies, Reading University, 1985), pp. 87–​90. 30 J. Manco, The Spirit of Care (Bath: St John’s Hospital, 1998), pp. 22–​3. 31 W. Page (ed.), Victoria History of the County of Warwick, Vol. II (London:  University of London, Institute of Historical Research, 1908), p.  111. Likewise, when the parish church of Saint Mary Magdalen, Thetford, became redundant in the early thirteenth century, John, earl of Warenne, the patron, assigned it as a chapel for his new leper house: F. Blomefield, An Essay towards a Topographical History of the County of Norfolk, 11 vols (London: W. Miller, 1805–​10), Vol. II, pp. 76–​7. 32 Roffey, ‘Medieval leper hospitals’, 223, 225. See also S.  Roffey, Chapter 5 in this volume, pp. 145–​6. An inventory of service books, vestments and plate made in c. 1400 reveals a striking level of liturgical provision at St Mary’s: London, BL, MS Harley 328, fos 28r–​30r. 33 Norfolk Record Office (NRO), Norwich, Consistory Court of Norwich, register Aleyn, fo. 9r.

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34 For strategies of commemoration in general, see B. Gordon and P. Marshall (eds), The Place of the Dead:  Death and Remembrance in Late Medieval and Early Modern Europe (Cambridge:  Cambridge University Press, 2000); and for the effects of these developments on hospitals, C. Rawcliffe, ‘A word from our sponsor:  Advertising the patron in the medieval hospital’, in J. Henderson, P. Horden and A. Pastore (eds), The Impact of Hospitals 300–​2000 (Bern: Peter Lang, 2007), pp. 167–​93. 35 Roffey, ‘Medieval leper hospitals’, 223. 36 Early Holborn and the Legal Quarter of London, ed. E. Williams, 2 vols (London:  Sweet & Maxwell, 1927), Vol. II, nos 1611, 1634, 1637; Satchell, ‘Emergence of leper-​houses’, p. 164; Calendar of Close Rolls, 1279–​1288 (London:  HMSO, 1902), p.  39; Records of the Borough of Northampton, Vol. II, ed. J. C. Cox (London: Corporation of the County Borough of Northampton, 1898), pp. 329–​30; P. M. Tillott (ed.), Victoria History of the City of York (Oxford: University of London, Institute of Historical Research, 1961), p. 397. It is worth noting that licences permitting the construction of chapels in leprosaria were often careful to restrict their use to members of the hospital community, lest revenues should be lost by neighbouring churches. See, for instance, the examples of Saint Thomas’s, Bolton (J. C. Hodgson, M. H. Dodds, K. H. Vickers et al., A History of Northumberland, 15 vols (Newcastle-​upon-​Tyne:  A. Reid, 1893–​1940), Vol. VII, p.  204), and Saint Leonard’s, Leicester, whose chapel stood next to the local parish church and could only be used by special arrangement with the patron of the living, the abbot of Saint Mary’s: J. Nichols, The History and Antiquities of the County of Leicester, Vol. I, 2 parts (London: J. Nichols, 1795), Part I, pp. 321–​2. 37 N. Comfort, The Lost City of Dunwich (Lavenham: Terence Dalton, 1994), p.  104. For further evidence of this important aspect of integration see Rawcliffe, Leprosy, pp. 258–​63. 38 By 1316 the church lacked parishioners and the leper house had ceased to receive the sick:  Calendar of Inquisitions Miscellaneous, Vol. II, 1307–​1349 (London: HMSO, 1916), no. 293. 39 N. Orme and M. Webster, The English Hospital 1070–​1570 (New Haven, CT: Yale University Press, 1995), p. 228. Some rural leprosaria boasted similar features. Two separate chapels, one easily accessible from the road and a second designed to safeguard ‘the semi-​monastic life of the permanent inmates’, were built at Saint Giles’s by Brompton Bridge in Yorkshire, which also offered accommodation to pilgrims: R. Gilchrist, Contemplation and Action:  The Other Monasticism (Leicester: Leicester University Press, 1995), pp. 51–​3.

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40 C. Rawcliffe, ‘The earthly and spiritual topography of suburban hospitals’, in K. Giles and C. Dyer (eds), Town and Country in the Middle Ages (Leeds: Maney, 2005), pp. 256–​7, 263–​4. 41 W. Page (ed.), Victoria History of the County of York, Vol. III (London:  University of London, Institute of Historical Research, 1913), p. 348. 42 When Bishop William Lynn confirmed Seffrid’s charter in 1363, he offered a further forty days’ remission to visitors: The Chartulary of the High Church of Chichester, ed. W. D. Peckham, Sussex Record Society, 46 (Lewes: Sussex Record Society, 1942–​43), no. 916, p. 289. For more examples of indulgences that required personal attendance, see Rawcliffe, Leprosy, pp.  321–​3. Testators, too, might well expect their executors to distribute alms to lepers in person, thereby more effectively soliciting prayers for their souls. See, for instance, the will made in 1498 by Katherine Kerre of Norwich, leaving 2d to ‘iche lepere’ in the city’s extramural leprosaria, ‘what tyme my executoris come there to vysyte them’:  NRO, Consistory Court of Norwich, register Hyrnyng, fos 49v–​50r. 43 London, BL, MS Cotton Faustina A III, fo. 322v. 44 In his study of the diocese of Bayeux, which maintained close connections with the Norman rulers and aristocracy of twelfth-​ century England, Damien Jeanne notes several ‘explicit references’ to communities of lepers who elected to pursue ‘a life of penitence under a monastic rule’. He also observes that the disease was then widely perceived as a mark of ‘divine election’: ‘Les léproseries du diocèse de Bayeux du XIe à la fin du XIVe siècle’, in F.-​O. Touati (ed.), Archéologie et architecture hospitalières de l’antiquité tardive à l’aube des temps modernes (Paris: Boutique de l’histoire, 2004), p. 336. An inventory of leper houses in the same diocese (pp. 357–​89) reveals evidence of many fine chapels. 45 The Later Letters of Peter of Blois, ed. E. Revell (Oxford:  Oxford University Press, 1993), no. 24, p. 119. Previously, in 1200, Innocent had issued a bull to the leper hospital of Saint Mary Magdalen, Hedon, permitting the burial of inmates and the celebration of divine service in times of interdict, which confirms that approval was then accorded on an ad hoc basis. Paradoxically, although the hospital had, from the time of its foundation in the 1170s, employed two priests and two clerks to serve thirty lepers in its chapel, it did not acquire papal approval for the construction of its own cemetery until 1208:  York, York Minster Library, MS B2 (3) a5; Rawcliffe, Leprosy, pp. 104–​5. 46 J. Cule, ‘The diagnosis, care and treatment of leprosy in Wales and the Border in the Middle Ages’, Transactions of the British Journal

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for the History of Pharmacy, 1 (1970), 29–58 (38, 41); Robert of Flamborough, Liber poenitentialis:  A Critical Edition with Introduction and Notes, ed. J. J. Francis Firth, Studies and Texts, 18 (Toronto: Pontifical Institute of Mediaeval Studies, 1971), pp. 150–​1. For other examples, see Avril, ‘Le IIIe Concile du Latran’, 26. 47 See, for instance, London, BL, MS Cotton Tiberius C V, fos 262r–​v, 263r, 264r, 265v, 267v, 268v (Doncaster); William Dugdale, Monasticon anglicanum, ed. J. Caley, H. Ellis and B. Bandinel, 6 vols (London: Longman, 1817–​30), Vol. VI, p. 654 (Hedon); London, BL, MS Harley 4015, fos 14r, 26r, 32v, 111r, 112r (Holborn); London, BL, Additional Charter 19137 (Maiden Bradley); London, BL, Additional MS 37503, fos 6v, 9r–​10r, 17v, 19v, 22v, 24r, 30v (Maiden Bradley). 48 Rawcliffe, Leprosy, pp.  265–​6. On the distinctive clothing worn by lepers, also see L. Barnhouse, Chapter 7 in this volume, p. 187. 49 Yorkshire Inquisitions, Vol. II, ed. W. Brown, Record Series, 23 (Worksop:  Yorkshire Archaeological Society, 1898), pp. 127–​ 8. Significantly, one of the arguments advanced by theologians who maintained that cloistered leprosi should not be regarded as professed religious hinged upon their payment of such fees, which technically constituted simony: Avril, ‘Le IIIe Concile du Latran’, 65. 50 R. B. Pugh and E. Crittall (eds), Victoria History of the County of Wiltshire, Vol. II (Oxford: University of London, Institute of Historical Research, 1956), p. 362. 51 London, BL, MS Cotton Nero D I, fo. 193r. 52 Historical Manuscripts Commission Twelfth Report, Appendix, Part IX (London: HMSO, 1891), pp. 426–​7. As in other hospitals, inmates who had taken orders were expected to recite the psalter or litany. 53 Ibid., pp. 410–​11. For the importance of gifts of candles to hospitals, see Rawcliffe, Leprosy, pp. 341–​2. 54 NRO, BL/​R/​8/​1, fos 1r–​27v. 55 The Making of King’s Lynn, ed. D. M. Owen, Records of Social and Economic History, new series, 9 (London:  British Academy, 1984), pp.  106–​8. 56 NRO, BL/​R/​81, fo.  27r–​v. 57 Ibid., fos 2v–​3r. 58 Ibid., fo. 26v. 59 Ibid., fo. 26v. 60 G. Le Bras, ‘Les Confréries Chrétiennes:  Problèmes et propositions’, Revue historique de droit français et étranger, 4th series, 19 and 20 (1940–​41), 310–63 (310). 61 C. Rawcliffe, ‘Communities of the living and of the dead:  Hospital confraternities in the later Middle Ages’, in C. Bonfield, T.

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Huguet-​ Termes and J. Reinarz (eds), Hospitals and Communities 1100–​1960 (Bern: Peter Lang, 2013), pp. 125–​54. 62 Materials for the History of Thomas Becket, ed. J. C. Robertson, 7 vols, Rolls Series, 67 (London: Longman, 1875–​85), Vol. I, pp. 428–​9. 63 The date and authenticity of this document are considered by R.  M. Haines, ‘A confraternity document of St Mary Magdalene’s hospital, Liskeard’, Bulletin of the Institute of Historical Research, 45 (1972), 128–​35, who revises some of his initial assumptions in R. M. Haines, Ecclesia anglicana:  Studies in the English Church in the Later Middle Ages (Toronto:  Toronto University Press, 1989), pp. 192–​200. For the attractions of indulgences as a more secure and reliable means of augmenting ‘a deposit account in the Treasury of Merit’, see R. N. Swanson, Indulgences in Late Medieval England (Cambridge: Cambridge University Press, 2007), pp. 519–​20. 64 C. Rawcliffe, ‘A crisis of confidence? The demand for hospital reform in early 15th-​and early 16th-​century England’, Parliamentary History, 35 (2016), 85–110 (102–4, 109)​. 65 E. Bishop, Liturgica historica:  Papers on the Liturgy and Religious Life of the Western Church (Oxford: Clarendon Press, 1918), p. 352. 66 C. Rawcliffe, ‘Passports to paradise: How English medieval hospitals and almshouses kept their archives’, Archives, 27 (2002), 2–22 (7–15).​ 67 Archdeaconry of Norwich:  Inventory of Church Goods temp. Edward III, ed. A. Watkin, 2 vols, Norfolk Record Society, 19 (Norwich: Norfolk Record Society, 1947–​48), Vol. I, p. 33. 68 Blomefield, Norfolk, Vol. II, p.  78. The leper house of Saint Mary Magdalen, with which Saint John’s was merged, owned a mortilegium in 1368: Watkin, Archdeaconry of Norwich, Vol. I, p. 33. 69 London, BL, MS Cotton Tiberius C V, fos 263r–​ 4v (Doncaster); Sweetinburgh, Role of the Hospital, pp. 122, 125 (Harbledown, where the names of special donors were inscribed on a prayer-​roll rather than being written in a book); London, BL, Additional MS 37503, fos 16r–​ v, 27r–​v (Maiden Bradley); Oxford, Bodleian Library, MS Rawlinson B.335, fo. 37v (Dover). 70 Oxford, Bodleian Library, MS Rawlinson B.335, fos 1v, 2v. 71 On reduced rations as a punishment within leprosaria, see E. Brenner Chapter 6 in this volume, pp. 171–2. 72 J. Duncombe and N. Battely, The History and Antiquities of the Three Archiepiscopal Hospitals at and near Canterbury, Bibliotheca Topographica Britannica, 4 (London:  printed by and for J.  Nichols, 1785), no. 35, pp. 211–​13; no. 45, p.  203. The regulations of Saint James’s, Chichester, confirmed in 1408, insisted that all new entrants should demonstrate their familiarity with the Pater Noster and

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Salve Regina ‘at least in the manner of the laity’ (‘ad minus more laicorum’):  London, BL, Additional MS 24828, fo. 143v. It was common for leper houses following a rule to permit lay inmates to substitute these prayers for the Latin liturgy recited by clerics: Kealey, Medieval Medicus, p. 109. 73 J. Stemmle, ‘From cure to care: Indignation, assistance and leprosy in the high Middle Ages’, in A. M. Scott (ed.), Experiences of Charity 1250–​1650 (Farnham: Ashgate, 2015), pp. 43–​61. 74 Calendar of Patent Rolls, 1381–​1385 (London: HMSO, 1897), p. 448. 75 F.-​O. Touati, ‘Les léproseries aux XIIème et XIIIème siècles: Lieux de conversion?’, in Bériou and Touati, Voluntate Dei leprosus, pp. 1–​32. 76 S. Thrupp, ‘The problem of replacement rates in the late medieval English population’, Economic History Review, 2nd series, 18 (1965–​66), 101–​19  (118). 77 On the decline of leprosy from the later Middle Ages onwards, see the Introduction to this volume, pp. 4–​5. 78 Rawcliffe, Leprosy, pp.  346–​8. For continental developments, see L. Demaitre, ‘Official objectives of the visitatio leprosorum: Ambiguity, ambivalence, and variance’, in C. Rawcliffe and C. Weeda (eds), Policing the Urban Environment in Premodern Europe (Amsterdam: Amsterdam University Press, 2019), pp. 271–​312. 79 Orme and Webster, English Hospital, pp.  127–​ 38; M. Rubin, ‘Development and change in English hospitals, 1100–​ 1500’, in L. Granshaw and R. Porter (eds), The Hospital in History (London:  Routledge, 1990), pp. 41–​ 59; Rawcliffe, ‘A crisis of confidence?’, pp. 86–​96. 80 Page, Victoria History of the County of York, Vol. III, pp.  323–​ 5; H. B. McCall, ‘St Mary Magdalene’s chapel, Ripon’, Yorkshire Archaeological Journal, 24 (1907), 219–​20. By 1363 lepers had long ceased to frequent the hospital of Saints Stephen and Thomas, Romney, whose once impressive lodgings and chapel (‘quae sumptuosa manus contruxerat’) had collapsed. The house was then re-​ founded as a chantry: Literae Cantuarienses: The Letter Books of the Monastery of Christ Church, Canterbury, ed. J. B. Sheppard, 3 vols, Rolls Series, 85 (London: Eyre and Spottiswoode, 1887–​89), Vol. II, pp. 437–​42. 81 The Register of Thomas Langley, Bishop of Durham 1406–​ 1437, Vol. V, ed. R. L. Storey, Surtees Society, 177 (Durham:  Andrews, 1962), p. 27. 82 Exeter, Devon Record Office, ED/​MAG/​43. By the 1380s the hospital housed nine such ‘decrepiti’: ED/​MAG/​50. 83 Brown, Yorkshire Inquisitions, Vol. II, pp. 123–​7.

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84 Although the chapel of Saint Mary Magdalen, which was used by the lepers, had by then become ‘badly roofed in part’, a ‘sufficient chalice’ and other plate, vestments and service books remained:  Calendar of Inquisitions Miscellaneous, Vol. II, no. 293, pp. 72–​3. 85 Calendar of Patent Rolls, 1374–​1377 (London: HMSO, 1916), p. 310. 86 ‘The leger book of St John’s Abbey, Colchester’, ed. J.  L. Fisher, Transactions of the Essex Archaeological Society, new series, 24 (1951), 77–​127 (121). 87 Sweetinburgh, Role of the Hospital, pp. 84–​5, 73–​4. Medieval English hospitals fell into three basic categories: those for the sick and disabled poor, for pilgrims and indigent travellers, and for lepers. In practice, though, distinctions were rarely so clear-​cut and changes in function were common, especially after the Black Death, when many institutions became almshouses. For a recent survey, see M. K. McIntosh, Poor Relief in England 1350–​ 1600 (Cambridge:  Cambridge University Press, 2012), Chapter 3. 88 C. Rawcliffe, ‘Dives redeemed? The guild almshouses of later medieval England’, The Fifteenth Century, 8 (2008), 1–27 (14–17)​. 89 F.-​O. Touati, ‘Historiciser la notion de contagion:  L’exemple de la lèpre dans les societés médiévales’, in S. Bazin-​Tacchella, D. Quéruel and E. Samana (eds), Air, miasmes et contagion: Les épidémies dans l’antiquité et au Moyen Age (Langres: Dominique Guéniot, 2001), pp. 157–​86. 90 Calendar of Charter Rolls, 1257–​ 1300 (London:  HMSO, 1906), p. 199. Kilwardby’s academic background, as a student in Paris and Oxford, may have prompted an interest in these comparatively novel ideas. Because it proved impossible to find a suitable incumbent who was prepared to live among the lepers at Harbledown, steps were taken in 1371 to provide a separate house, opposite the gates, for a chantry priest:  Duncombe and Battely, History and Antiquities of the Three Archiepiscopal Hospitals, no. 34, pp. 209–​10. 91 Dugdale, Monasticon anglicanum, Vol. VI, p.  630. That Bishop Stratford also considered relations with the healthy to be scandalous (‘scandalosa’) was presumably because they reflected so badly upon the hospital’s failure to provide essential spiritual services and thus keep the lepers securely at home. 92 Beverley Town Documents, ed. A. F. Leach, Selden Society, 14 (London: B. Quaritch, 1900), p. 42. 93 Calendar of Letter Books of the City of London: Letter Book G, ed. R. R. Sharpe (London:  John Edward Francis, 1905), pp. 27–​9 (my emphasis). It was agreed that free places might be offered to residents of Middlesex who had contracted leprosy, should there be insufficient demand from London.

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94 Calendar of Patent Rolls, 1367–​1370 (London: HMSO, 1913), p. 64. For the struggle to hold the Lazarites to account, see D. Marcombe, Leper Knights:  The Order of St Lazarus of Jerusalem in England, c. 1150–​1544 (Woodbridge: Boydell Press, 2003), pp. 161–​8. 95 London, BL, MS Harley 4015, fos 110r, 111r. 96 For continuing anxiety about the presence of vagrant lepers in and around the city, along with more general fears of miasma and contagion, see Rawcliffe, Leprosy, pp. 274–​84. 97 The Book of Margery Kempe, ed. S. B. Meech, Early English Text Society, original series, 212 (London:  Early English Text Society, 1940), p. 176. On the association between kissing lepers and sanctity, see C. A. Krolikoski, Chapter 9 in this volume. 98 Owen, Making of King’s Lynn, p. 213. It is impossible to establish the foundation dates of Lynn’s various leprosaria, or, indeed, to discover precisely how many of them functioned at any given time. Local wills refer to four in 1309, seven in 1361 and 1382, and six in 1432, but are far from consistent:  The Red Register of King’s Lynn, ed. R. F. Isaacson and H. Ingleby, 2 vols (King’s Lynn: Thew & Son, 1919–​21), Vol. I, p. 2; Blomefield, Norfolk, Vol. III, p. 528; King’s Lynn, King’s Lynn Borough Archives, KL/​C12/​1/​3, 5. 99 Isaacson and Ingleby, Red Register, Vol. II, p.  122; King’s Lynn Borough Archives, Kl/​C7/​2, Hall Book, 1422–​29, p. 242. 100 Meech, Book of Margery Kempe, p. 177. Margery’s confessor would not permit her to kiss the men, no doubt recalling Hugh of Lincoln’s celebrated practice of segregating the sexes before he embarked on this act of reverence for Christus quasi leprosus: Rawcliffe, Leprosy, pp. 144–​5. 101 Meech, Book of Margery Kempe, p. 176. 102 The Liber celestis of St Bridget of Sweden, Vol. I: Text, ed. R. Ellis, Early English Text Society, original series, 291 (Oxford: Early English Text Society, 1987), p. 22. 103 Rawcliffe, Leprosy, pp. 109–​10, 320–​1. For the popularity of leper houses with fifteenth-​century testators, see P. Maddern, ‘A market for charitable performances? Bequests to the poor and their recipients in fifteenth-​century Norwich wills’, in Scott, Experiences of Charity, pp. 79–​103 (pp. 94–​5). 104 London, BL, Additional MS 27582, fo. 71r. See also Here Begynneth a Litill Boke Necessarye & Behouefull agenst the Pestilence (London:  W.  de Machlinia, 1485), fo. 3v; R. Palmer, ‘The Church, leprosy and plague in medieval and early modern Europe’, Studies in Church History, 19 (1982), 79–​99 (pp. 86, 89). 105 H. Harrod, Report on the Deeds and Records of the Borough of King’s Lynn (King’s Lynn: Thew & Son, 1874), p. 79. For the impact

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of the 1361 pestilence on Lynn, see A. Gransden, ‘A fourteenth-​ century chronicle from the Grey Friars at Lynn’, English Historical Review, 72 (1957), 270–​8 (275). 106 This point is developed in C. Rawcliffe, Urban Bodies:  Public Health in Late Medieval English Towns and Cities, c.  1250–​1530 (Woodbridge:  Boydell Press, 2013), pp. 90–​1. Such events had an important political, as well as a religious, dimension and could prove controversial. The impressive annual procession staged by the officials and citizens of Canterbury to present gifts and hear mass at the leprosarium of Saint Laurence degenerated into a full-​blown riot in 1436 because of jurisdictional disputes between the city and the monks of Saint Augustine’s abbey, who ran the hospital:  S.  Sweetinburgh, ‘Placing the hospital:  The production of St Lawrence’s hospital registers in fifteenth-​century Canterbury’, The Fifteenth Century, 13 (2014), 109–​29 (112–​13). 107 M. Rubin, Charity and Community in Medieval Cambridge (Cambridge: Cambridge University Press, 1987), pp. 119–​24. 108 Cambridge Borough Documents, Vol. I, ed. W. M. Palmer (Cambridge: Bowes & Bowes, 1931), pp. 55–​6. These strategies for commemoration reflect trends throughout the Christian West. See, for example, M. S. Doquang, ‘Status and the soul: Commemoration and intercession in the Rayonnant chapels of northern France’, in E. Brenner, M. Cohen and M. Franklin-​Brown (eds), Memory and Commemoration in Medieval Culture (Farnham: Ashgate, 2013), pp. 93–​118. 109 Duffy, Stripping of the Altars, pp. 91–​130. 110 Dorchester, Dorset Record Office, DC/​BTB AB42, AB43. A précis of these documents may be found in Historical Manuscripts Commission Sixth Report, Appendix (London: HMSO, 1877), pp. 485–​6. 111 As, for example, at Saint Nicholas’s, York, in 1285: Brown, Yorkshire Inquisitions, Vol. II, p. 30; and, more generally, Rawcliffe, ‘A crisis of confidence?’, 96, 103, 109. 112 Sweetinburgh, Role of the Hospital, p. 87. Thus, for instance, when the hospital of Saint Nicholas, Royston, was moved to another site in 1305, the principal requirement was that a new chapel should be built for the daily celebration of mass on behalf of the founders and their heirs: London, BL, Harley Charter 112 A 3. By 1359 the lepers had decamped, refusing ‘to come or to dwell there’, but the house still discharged its main function as a chantry: Calendar of Close Rolls, 1354–​1360 (London: HMSO, 1908), p. 587. 113 Records of the Borough of Nottingham, Vol. III:  1485–​1547, ed. W. H. Stevenson (London: Quaritch, 1885), pp. 150–​4.

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14 Swanson, Indulgences, p. 414. 1 115 Historical Manuscripts Commission Sixth Report, Appendix, p. 488. Swanson, Indulgences, pp. 210–​11, notes that collecting in kind for hospitals was common, since the goods could either be sold on the spot to raise money or ‘returned to base’. Donors to the Bridport leprosarium were actively encouraged in 1467 to give ‘broche, rynge, boke, belle, candell, vestimente, brodclothe, towelle, pygge, lambe, wolle, peny, or penyworthe’ in return for the remission of a seventh part of enjoined penance: Dorset Record Office, DC/​BTB AB46. 116 Rubin, Charity and Community, p. 146. 117 More, Complete Works, Vol. VII, p. 205. The offering of commendatory prayer had long been recognised as the most important of the Seven Spiritual Works: Saint Thomas Aquinas, Summa theologica, ed. B. M. de Rubeis and C. R. Billuart, 6 vols (Turin:  Pietro Marietti, 1894), Vol. 3, II, part 2, question 32, articles 2–​4.

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5 Saint Mary Magdalen, Winchester: the archaeology and history of an English leprosarium and almshouse Simon Roffey Between 2008 and 2015 extensive archaeological excavations were conducted at the former leprosarium and hospital of Saint Mary Magdalen, Winchester, Hampshire, England (Figure  5.1). This work represents one of the first wide-​scale excavations of an English leprosarium with its associated cemetery,1 and has allowed for the cross-​comparison of different forms of archaeological data, including burial, artefactual and structural material. It has also

Figure 5.1  View of the excavations of Saint Mary Magdalen, Winchester, looking west towards Winchester.

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provided an important insight into the origins and development of one of the earliest leprosaria, and indeed hospitals, in the country, for which little documentary evidence survives. This chapter will place the history and archaeology of Winchester’s leprosarium and later hospital in the context of comparative examples and wider debates concerning the archaeology of medieval leprosy hospitals in England.2 In particular, this chapter will illustrate the contribution of archaeology to the study of leprosy and identity in the medieval period, and will reveal what the materiality of leprosy communities can tell us about the status of people with leprosy, and the treatment of both the living and the dead. Some studies of medieval leprosy hospitals have conventionally grouped such institutions under the wider generic umbrella of ‘medieval hospital’. Yet as we will see, many early leprosy communities, or leprosaria,3 represented a distinctive type of religious community, and their specific structure and development warrant particular attention. Using the case study from Winchester, this chapter will investigate the archaeological evidence of the development of a medieval leprosy hospital over time:  from its origins as a small dedicated community, or leprosarium, through to a more formal and regulated institution in the later period. It will also investigate the nature of the community at such an institution, and its wider relationship and integration with medieval society.

Leprosy and leprosaria in medieval England Leprosy has afflicted humankind since antiquity and references to leprosy can be found in a diverse range of early sources as well as in evidence from the archaeological record. The earliest-​known human remains showing suspected skeletal evidence of the disease may date back almost 4,000 years,4 and in Britain cases are known from the fourth century onwards.5 However, the disease reached endemic levels throughout the Middle Ages, and in recent years some knowledge of the nature of medieval strains of leprosy has emerged from bioarchaeological studies of cases, with whole genome retrieval of a handful of European examples, including cases from Winchester.6 Evidence for the decrease in leprosy hospital foundations, as well as the archaeological evidence for

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leprosy burials in the later medieval period, indicate that leprosy was in decline from the fourteenth century onwards. The reasons for its decline have been the subject of speculation, but may include susceptibility of sufferers to other infectious diseases such as plague, as well as tuberculosis, another mycobacterium against which leprosy victims would have had little resistance.7 The first documented English leprosarium was founded at Harbledown, Canterbury, Kent, by Archbishop Lanfranc (1070–​89) sometime in the 1080s. Lanfranc established two other hospitals at Canterbury at this time: Saint John’s, for the sick, the poor and the elderly, and Saint Gregory’s, which catered for the sick only briefly, becoming an Augustinian priory in the first part of the twelfth century.8 However, the comparison of these two ‘hospital’ foundations with that of the leprosarium at Harbledown warrants further attention. Archaeological evidence, together with the contemporary descriptions by the eleventh-​ century chronicler Eadmer,9 reveals that both Saint Gregory’s and Saint John’s hospitals had ordered, claustral arrangements with well-​appointed buildings.10 Located on the very edge of the city, their foundation reflected charitable patronage in early Norman England that was ordered along monastic lines.11 In contrast to the leprosarium at Harbledown, ‘hospitals’ such as Saint John’s and Saint Gregory’s, and other examples, were not necessarily founded in reaction to an increase in disease. In contrast, the leprosarium at Harbledown, founded on a hill, took the form of a group of timber dwellings, a masonry chapel and an ordered cemetery, and is therefore more indicative of an exclusive, separated community and one that was perhaps as much reactionary as planned. Leprosaria like that at Harbledown were thus created in reaction to the spread, or increased visibility, of leprosy in western Europe in the later eleventh century. Here, then, we might see early leprosaria as more like ‘quasi-​religious and supportive communities’ than formalised hospitals (which many were later to become), and providing a particular dynamic and immediate context and contingency for those suffering from leprosy. Overall, these institutions, whether leprosaria or more formal hospitals, may have evolved as a consequence of specifically Benedictine attitudes to care of the sick, and in the English context,

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may have been inspired by Lanfranc’s Benedictine connections as a monk of Le Bec and abbot of Saint-​Etienne, Caen. The Benedictine Rule ordered that monks were to set aside places for the care of sick brethren and to appoint a warden to look after them.12 In fact, although the Augustinians increasingly oversaw hospital foundations in Europe from the twelfth century, no other Rule brought together ‘such a complete program of treatment for the sick’.13 Both leprosaria and hospitals developed as a response to sickness and disease (and its possible escalation), as well as marking a compassionate response by the Church in order to provide formal care. These two responses are not necessarily mutually exclusive. Many hospitals were also organised as monastic communities, and the pursuit of a religious vocation by their staff, as well as the care of the sick, must have motivated their foundation.14 Indeed, by tending to the sick, hospital staff fulfilled one of the biblical works of mercy. A similar set of circumstances to Lanfranc’s Harbledown may have also existed at Winchester, where, as we shall see, the archaeological evidence suggests a foundation of comparative date and of a similar organisation and location. It is perhaps significant that the early Norman institutions at Canterbury and Winchester pre-​dated any recorded comparative institution in Normandy itself, although the hospital for the sick poor at Rouen possibly dates from the eleventh century or earlier.15 This evidence may suggest that such institutions did not develop out of a specifically ‘Norman’ context, but perhaps operated in tandem with similar developments on the Continent. The impetus may of course be due to the inspiration and innovation of dynamic churchmen such as Lanfranc and Walkelin, bishop of Winchester (1070–​98). However, late Anglo-​Saxon society certainly presented both the conditions and a socio-​religious context for the evolution of the hospital. Here, a fragmentary documentary record and archaeological evidence suggest an institutional basis for the care of the infirm and diseased, possibly as early as the tenth century. The curing of leprosy sufferers features regularly in some of the hagiographic and homiletic writings of the late Anglo-​ Saxon period,16 and various medical treatises exist from the late ninth and tenth century, including the Old English Herbarium; the Lacnunga; and Bald’s Leechbook, a work with possible Winchester connections.

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More significantly, archaeology is providing a growing body of evidence for the organised burial of leprosy sufferers in the late Saxon period. At Norwich, excavations in the medieval churchyard of Saint John’s Timberhill (Castle Mall) revealed a series of burials, around a fifth of which presented evidence of leprosy.17 Radiocarbon dates of eighteen individuals suggested that the burial ground came into use between 980 and 1030 CE (calibrated, 95 per cent probability) and went out of use between 990 and 1050 (calibrated, 95 per cent probability). No associated buildings were found; however, we cannot rule out the possibility of structures, as later burials may have destroyed them, or they could lie under the site of the later church. Overall, the evidence suggests that this pre-​Norman group of leprous burials may have been part of a ‘community’ of leprosy sufferers, ‘or perhaps even a village’.18 Such an arrangement may have also been echoed a few decades later at Harbledown and Winchester. The documentary evidence for the foundation of leprosy hospitals in the immediate decades following the Norman Conquest implies that leprosy was becoming a social issue at this time, and one that necessitated a formal institutional response –​although here it may also be argued that if leprosy was a growing problem prior to their arrival, the Normans may simply have regulated, institutionalised or documented what was already in existence.19 The evidence suggests that the early institutions consisted of fairly simple arrangements. Eadmer recorded that the leprosarium at Harbledown comprised timber buildings clustered around a chapel.20 This rather simple configuration is mirrored in the archaeological evidence for the early leprosy hospitals at Saint Nicholas Farm, Saint Andrew’s, Fife, Scotland,21 and in England at Brompton on the Bridge in North Yorkshire, Colchester in Essex and Old Sarum in Wiltshire,22 as well as at Winchester. Apart from these documented examples there are likely to have been many more, unrecorded, smaller communities of leprosy sufferers. The thirteenth-​century Life of Saint Hugh of Lincoln referred to communities of leprosy sufferers on bishops’ manors.23 Such rural groups may have been the earliest form of leprosy-​related community and would presumably have left little or no trace in the records. Archaeologically, they may also be difficult to distinguish from small farmsteads or secular dwellings, especially as they may have not necessarily had chapels or cemeteries.

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Despite a relatively high number of leprosy hospitals founded in England between the late eleventh and thirteenth century  –​ representing perhaps as much as a quarter of all medieval hospitals  –​archaeological evidence for the institutional context of medieval leprosy is rather limited. Unlike the many medieval churches and monastic buildings still standing, the survival of leprosy hospital buildings is rare. Partial survivals include the chapels at Stourbridge outside Cambridge, Saint Bartholomew’s outside Oxford, Glastonbury in Somerset and the Lazar House in Norwich. Moreover, in contrast to monastic sites and the greater hospitals for the sick poor, such as at London and Bristol,24 only limited excavation has been carried out on English leprosy hospitals to date. One reason for this deficiency may be that almost all medieval leprosy hospitals were founded on the periphery of towns:  areas that today consist of built-​ up suburbs and urban extension, where little opportunity exists for extensive, long-​term archaeological work. Many leprosy hospitals were in decline by the fifteenth century and a number were subsequently refounded as different forms of institution. In many cases, such as at Canterbury, Colchester, Taunton and Winchester, former leprosaria were converted to almshouses built for the individual care of the poor, infirm and elderly. Such transformations would have often entailed the redevelopment of earlier buildings and their replacement with structures more suitable for individual or private accommodation. Yet  although we know little concerning the buildings of these institutions, a little more work has been carried out on the cemeteries, often undisturbed by later above-​ ground changes. Examples of published excavated leprosy hospital cemeteries include High Wycombe in Buckinghamshire,25 and South Acre in Norfolk,26 and in particular the cemetery of Saint James and Saint Mary Magdalen, Chichester, West Sussex, with its excavation of 384 skeletons from the leprosy hospital and later almshouse.27 Overall these cemetery excavations have presented an important set of pathological information that can shed light on both the physical manifestations of leprosy, and the disease’s implications for those who lived and died in such institutions, although many of these studies have targeted the cemeteries alone, without reference to their associated hospital buildings. However, this is largely due to the practicalities of the excavations, since many of the above

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sites were ‘rescue’ excavations where archaeologists lacked the time, resources or opportunity to undertake comparative structural investigation. Archaeological research at the leprosy hospital and cemetery of Saint Mary Magdalen, Winchester, is therefore of some significance. Here, intensive excavations over an eight-​year period have revealed evidence of two separate cemeteries (see Figures 5.4 and 5.5.), an early timber phase of occupation and later masonry buildings, including some form of claustral arrangement, as well as a late medieval almshouse. The work at Winchester constitutes an important addition to our understanding of leprosaria in medieval England, in terms of their development, their spatial organisation, the physical condition of their residents and extent of disease, and the relationship between hospital communities and wider society. Results from the excavations suggest that Winchester was home to one of the earliest-​dated leprosy hospitals and had a central role in the development of early institutional health care in medieval England.

Saint Mary Magdalen, Winchester: origins and topography In 2007, the department of archaeology at the University of Winchester initiated the Magdalen Hill Archaeological Research Project (MHARP) with the aim of studying the history and development of the leprosy hospital and almshouse of Saint Mary Magdalen, Winchester.28 In late 2007 and early 2008, MHARP carried out an evaluation and desk-​based assessment of the site, including field and geophysical surveys, together with an assessment of primary and secondary documentation, discussed below. The geophysical (resistivity) survey indicated a range of features that clearly related to the former hospital complex. Consequently, excavations commenced in the summer of 2008. The site of Magdalen Hill is presently used for arable farming and is located 1.6 km (1 mile) east of the city of Winchester. The field is bordered on its southern side by the Alresford Road, once the old Winchester-​to-​London road, and to the east by Fair Lane, which once led to the later medieval fair held on the land to the south and across the road from the hospital. The former hospital

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is situated on a high downland ridge above the city at a height of 93 m above OS datum, and the area today is still is known as ‘Magdalen’, or ‘Morne’, Hill. The hilltop location mirrors that of comparative Norman leprosy hospitals at Canterbury and Rouen, Normandy, and may possibly be a specific characteristic of some early foundations. Hilltop locations could suggest early attempts to separate or contain leprosaria, or be to do with salubrious clear air (one of the non-​naturals that influenced health). Fresh water, as well as having obvious practical benefits, was also often associated with having curative and restorative powers. Some hospitals may have been close to natural water or springs, as at Bath, or have had their own wells. The presence of a well, the only surviving feature of the hospital, marks the site of the former hospital at Winchester. Although the well’s date and original function are unknown, it was only within a metre or so of the hospital buildings. The hospital’s extramural location, a mile east of Winchester, is typical of leprosarium foundations, a pattern that can also be seen, for example, at Chichester, London, Norwich and Southampton. At Canterbury, Eadmer refers to the leprosarium at Harbledown as being ‘further removed, beyond the western gate of the city’.29 In the case of Winchester the leprosarium was particularly well placed, within open fields on the border of the substantial medieval suburb of Saint Giles. The hospital’s proximity to the Winchester-​to-​London road suggests that it was not isolated, since this road would have carried a regular amount of traffic. Indeed, the important medieval market fair at Saint Giles was half a mile further down the road and was increasingly popular from the early twelfth century onwards. A close proximity to this important medieval thoroughfare would suggest that the leprosarium had regular contact, and was fairly well integrated, with the medieval town and its hinterland. The hospital, one can imagine, would also have provided a particularly prominent monument for its founder. There is no documentary evidence relating to the foundation of the hospital at Winchester; its dedication to Saint Mary Magdalen can only be dated to the twelfth century. To date the leprosarium’s origins, as we shall see, we must rely on the archaeology. However, it is clear from the earliest surviving references that the bishops of Winchester had a long-​term influence on the hospital, and it is likely that one of the

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bishops was the initial founder. No charters or cartularies survive from the leprosy hospital at Winchester, and historical references to the institution in the twelfth century are limited. Overall the surviving documentary record does, however, provide some important supporting information for the archaeological investigation, as well as a useful overview of the hospital’s later history, particularly regarding episodes of reorganisation and transformation in the later Middle Ages. Of particular importance are a set of antiquarian descriptions recording the state of the buildings prior to demolition in 1789. These descriptions include a series of commissioned illustrations undertaken by the artist Jacob Schnebbelie (1760–​92) that depict the interior of the medieval chapel, as well as some of the later, post-​ medieval buildings and precinct. It is clear from these drawings that much mid-​to-​late-​twelfth-​century fabric survived intact in the chapel prior to the 1780s, which provides some firm, dateable evidence for this building at least.30 The foundation of the hospital has often been ascribed to Bishop Richard Toclyve (1173–​88), in 1180. This date was originally conjectured by local historian John Milner from the architectural drawings of the chapel interior supplied by Schnebbelie.31 This date was perpetuated through further historical studies of the site.32 However, other commentators have suggested that the founder was probably Henry de Blois, bishop of Winchester between 1129 and 1171.33 This attribution is apparently based on a fourteenth-​century tradition that the bishop had originally endowed the hospital with an annual income of £25 19s 4d.34 A sum of 60s was likewise paid annually to the hospital from the revenues of the city.35 Certainly, the site is referred to in the Winton Domesday of 1148, within de Blois’s tenure, where a reference to the ‘lepers on the hill’ is given. This confirms the presence of a community but provides no specific detail regarding its particular form, excepting that it is also reported as having claimed £1 1s 0d in rents from three houses.36 The ownership of rents would suggest that the hospital was formally organised at this time, and this is further supported by the archaeological evidence presented below. This payment of rents was also noted in 1155–​56 (Pipe Roll 3 Henry II) but is not referred to in the earlier Pipe Roll of Henry I in 1133 (Pipe Roll 31 Henry I).37 Schnebbelie’s illustrations of the 1780s show a chapel interior decorated in a late Romanesque and Transitional style of the second half of the twelfth century, and would therefore support a foundation

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Figure 5.2  Interior of the medieval chapel of Saint Mary Magdalen, Winchester, looking east, prior to its destruction in the 1780s. Note image niche and altar squint in north aisle, formerly the site of a side altar, or chantry foundation.

during the tenure of Bishop de Blois (Figure  5.2). Nonetheless, a more complex picture emerges from the excavations. Investigations of the chapel uncovered a medieval building of later-​twelfth-​century date that would certainly fit Schnebbelie’s description. Parallel to and north of this chapel excavations revealed a substantial masonry hall or infirmary. To the south of the chapel, part of the documented cemetery was uncovered with burials presenting evidence of leprosy. It is likely that these buildings and the southern cemetery represent a hospital dating to de Blois’s time and would support the early references to the hospital’s presence, noted above, from 1148 onwards. However, underlying and partly concealed by all these mid-​twelfth-​century features was evidence of an earlier phase of occupation represented primarily by substantial post-​pits, post-​holes and linear features indicative of former timber structures, as well as an associated earlier cemetery, on the north side of the chapel. Furthermore, the east end of the chapel encased the wall of a small, earlier, masonry structure (Figure 5.3). This presented the possibility of an earlier chapel, pre-​dating that depicted by Schnebbelie. A line

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Figure 5.3  Excavations of the east end of the chapel of Saint Mary Magdalen, Winchester, looking south. Note the two parallel east-end walls. That to the right of the picture shows the original east wall of the late-eleventh-century chapel. This was replaced by the later wall (to the left), representing a rebuilding and extension of the chapel in the later twelfth century.

of post-​ pits to the north of this masonry structure also suggest the presence of an earlier, timber hall. Other seemingly associated post-​holes and linear features may indicate further buildings and boundaries. Between the early chapel and the timber buildings was a small cemetery (Figure 5.4). Pottery retrieved from this phase of occupation was generally of an Anglo-​Norman character. Taken as a whole, this evidence seemed to propose a hospital founded in the immediate decades following the Norman Conquest, and one that may mirror that founded by Archbishop Lanfranc at Canterbury in the 1080s. Certainly Winchester had many similarities with the archbishop’s foundation. Winchester’s masonry chapel with outlying timber buildings and cemetery is comparable with the arrangement at Canterbury described by Eadmer.38 Both are situated on hills close to what were important urban administrative and ecclesiastical centres during the Anglo-​Norman period.

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Figure 5.4  The cemetery of Saint Mary Magdalen, Winchester, looking north. The north wall of the medieval chapel can be seen in the foreground.

Material evidence from Winchester: burials and building structures It was clear that the burials in the northern cemetery were associated with this initial phase of the hospital. Over 100 burials were excavated from the site in total, the majority of which comprised chalk-​ cut anthropomorphic graves with inner ledges and head niches towards the west (Figure  5.5).39 This particular form of burial custom, which is normally found in high-​status ecclesiastical contexts, implies that a certain level of status was afforded to these

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Figure 5.5  View of the northern cemetery at the leprosarium of Saint Mary Magdalen, Winchester. Note the chalk-cut anthropomorphic graves with inner ledges and head niches. Very few graves are truncated, suggesting that they probably had burial markers. The graves can be seen to underlie the later phases of the hospital and almshouse.

individuals, a picture that conflicts with traditional perceptions of leprosy sufferers as outcasts.40 Over 85 per cent of burials presented evidence of leprosy. This is a much larger percentage than has previously been recorded in any British material, with 75 of 384 burials (19.5 per cent) from the cemetery of the leprosy hospital at Chichester recorded as showing definite evidence of leprosy,41 while a very similar percentage (19.4 per cent) was recorded among the burials from the Saxo-​Norman cemetery at Norwich, discussed above.42 The high incidence of leprosy at Winchester suggests not only a successful and effective standard of diagnosis, but also an institution almost wholly dedicated to the care of leprosy sufferers: in short, a specialist facility. Carbon-​ 14 radiocarbon dates for one burial provided a calibrated date of 980–​1160 CE (95 per cent probability). Another sample from a second burial provided a similar dateline of 1010–​ 1160 (calibrated, 95 per cent probability). A further sample from the former individual corroborated these findings, presenting a

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date of 890–​1040 (95 per cent probability, and 90 per cent within 940–​1040).43 Another associated burial with evidence of early-​ stage leprosy, probably a pilgrim, discussed below, provided a date range of 1020–​1162 (95 per cent probability). Taken as a whole the radiocarbon dates indicated that the cemetery was in use before 1100, and this may confirm a foundation date sometime between c. 1070 and c. 1100. Nonetheless, the possibility of an earlier pre-​Norman date cannot yet be completely ruled out.44 Two burials in the northern cemetery were of particular interest and gave some insight into the nature of the community at Winchester. One male individual showed signs of amputation of the lower left leg, and possible related medical care, since there were indications that the wound had healed.45 Another burial (Figure  5.6), again a male, with some indications of early-​stage leprosy, was found with a scallop shell on the left side of the pelvis that had been pierced by two holes, presumably for attachment to a scrip or bag.46 These pierced shells are associated with pilgrimage to the shrine of Saint James at Santiago de Compostela, Galicia, Spain, with such shells being sold to pilgrims outside the shrine. Santiago was the only place permitted to distribute these shells, under pain of excommunication, although ‘fake’ shells are also thought to have been sold during the medieval period.47 However, the shell buried with the Winchester individual has been identified as a specimen of Pecten maximus, which is found in Atlantic waters, including along the Galician coast, and is the species of shell that would have been given to a pilgrim who had completed the pilgrimage to Santiago.48 Thus, the leprous individual buried at Winchester had undertaken a pilgrimage to Compostela.49 The fact that he or she was buried with this pilgrim’s badge indicates that this was an achievement of some significance. Whatever the details concerning the early foundation at Winchester, it is clear from the archaeological evidence that this initial phase was supplemented by the addition of storage facilities. This was represented by the construction of a very large, parallel-​ sided, ‘cellared’ structure (approximately 5  × 5 m) cut into the chalk at a depth of over 4 m (see Figure 5.7). The bottom of this feature appears to have been lined with wattle and there was evidence of burning. The pottery retrieved here was again of an Anglo-​Norman character. A likely interpretation is that it was used

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Figure 5.6  Pilgrim burial with in situ scallop shell from Saint Mary Magdalen, Winchester.

for long-​term storage of provisions and relates to the first phase of the leprosarium. Consequently, it may point to a certain level of self-​sufficiency and to the organisation of communal provisions at this time.

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Figure 5.7  Excavation of the twelfth-century masonry hall, probably an infirmary, at the leprosarium of Saint Mary Magdalen, Winchester (looking north-west). Note the earlier cellar feature to the west of the site, and post-hole structures, underlying the infirmary, both probably relating to the first leprosarium founded in the eleventh century. The brick wall running across the hall dates to the later medieval period when the medieval hall was subdivided to form almshouses.

The archaeological evidence suggests that the cellared feature was later back-​ filled with redeposited chalk and a mortar-​ and-​ rubble platform, which was used to carry the south wall of a large masonry hall. This latest building was probably a new hospital infirmary (Figure  5.7). The small masonry chapel to the south was also rebuilt at this time. Overall, this phase of development could indicate the re-​establishment of the site as a more formal leprosarium, or hospital. It may further suggest why the hospital appears in the Pipe Rolls of 1155–​56 (Pipe Roll 3 Henry II), but not in the earlier Pipe Roll of 1133, referred to above.50 The refoundation of the hospital under de Blois would also coincide with other Winchester building programmes initiated by the bishop, including a substantial rebuilding project at Wolvesey Palace and the foundation of the hospital of Saint Cross in the late 1130s. As noted above, Schnebbelie’s drawings of the chapel indicate that

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work on this building was completed by some twenty years or so later. In 1773, the chapel was described as consisting of ‘three iles’ with a roof ‘supported by two rows of columns, five on each side, with pointed arches’.51 Examination of the building materials of the probable infirmary and the chapel during their excavation indicated that they were contemporaneous. Both buildings had flint-​faced walls with rubble cores, with a hard, orange mortar unlike that presented by the buildings of later medieval phases. These buildings effectively mark the end of the earlier phases of occupation of the site, including the ‘northern cemetery’ and associated archaeological features that had clearly gone out of use by that time. A new cemetery to the south of the chapel was also commissioned during this phase, and two of the five burials excavated from this later cemetery presented evidence of leprosy. The mode of burial in this cemetery was markedly different from that of the earlier northern cemetery. Here in this southern cemetery, the graves lacked clear definition and did not have head niches. Many graves were also truncated, suggesting that, again unlike the northern cemetery, the individual graves were not marked. Here, the contrasting forms of the leprosy burials may imply a changing relationship to those suffering from leprosy between the later eleventh century and the mid-​twelfth century. Overall, the evidence from Winchester suggests that Saint Mary Magdalen was one of a group of pioneering establishments of charitable health care that were established in the last few decades of the eleventh century around important and busy urban centres. Such arrangements emerged as a specific and directed response to an acceleration of disease, only later becoming properly formalised and regularised –​a change in status that, by the mid-​twelfth century at Winchester, was necessitated and articulated through the construction of an institution along more monastic-​based lines. And it is here, perhaps, that we can see the emergence of the hospital proper.

The leprosarium of Saint Mary Magdalen, Winchester, in the later Middle Ages The evidence from the thirteenth century onwards depicts a hospital subject to varying periods of decline and renewal. Late

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in the thirteenth century the Register of Bishop John of Pontoise (1280–​ 1304) lists Saint Mary Magdalen among those benefices of which the bishop of Winchester had been a long-​time patron.52 The hospital was still functioning as a leprosarium, to some extent, during the fourteenth century, as it is referred to as such in Bishop Stratford’s Register of 1325.53 In 1333, Pope John XXII granted an annuity to the prior and chapter of ‘Winster’54 to buy the church of Wonsington, of the value of £40, out of which £25 19s 4d was set aside for the ‘hospital of Mary Magdalen’.55 The foundation at this time, we are informed, consisted of a priest (presumably the master), nine poor brothers and nine poor sisters.56 However, ensuing years witnessed a change in fortune, and the hospital may have experienced financial difficulties. In 1334, the keepers of the ‘temporalities’ of the See of Winchester were ordered to pay the master and paupers of the hospital the ‘arrears of a certain fixed sum for their maintenance’.57 Only two years later, we hear that the hospital was ‘so slenderly endowed that its goods hardly sufficed for the maintenance of the masters and brethren and sisters of the hospital, and the weak and infirm there, and for other alms according to the foundation’.58 The hospital’s decline at this time may have led to a subsequent refoundation sometime in the mid-​fourteenth century as a Maison Dieu, possibly by Maria de Valentia, duchess of Pembroke.59 This would have presumably supported considerable reorganisation of the hospital, and it appears to have attracted renewed endowments from this point on. In 1356 five messuages were given to Saint Mary Magdalen by Thomas Devenish.60 One or possibly two of these were situated in the centre of the commercial area of Winchester on the corner of Jewry Street and Fleshmonger Row.61 A few years later, in 1369, the hospital was endowed with more prime property south of the cathedral.62 The reorganisation and renewal of Saint Mary Magdalen, Winchester, paralleled a wider ‘period of innovation’ witnessed by English hospitals during the second half of the fourteenth century.63 Excavations at Winchester revealed that building works took place at this time, presumably funded by lay endowments. The twelfth-​ century infirmary hall was partially restructured with the addition of a south aisle, and possibly a further aisle, or alternatively a form of claustral arrangement to the north. The presence of partition slots and small tiled hearths at the western end of the infirmary south aisle

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Figure 5.8  West end of the medieval infirmary at Saint Mary Magdalen, Winchester. Note the burnt floor surface and linear slots (left) suggesting that the hall was partitioned at some point. The misalignment with the later, brick almshouse interior wall (right) indicates that the partitions pre-date the almshouse phase and are therefore of medieval date.

indicated that the aisle was divided into cells, perhaps suggesting some level of privacy for individual residents, which would have foreshadowed the later almshouse (Figure  5.8). Schnebbelie’s illustration of the chapel interior suggests that the north aisle of the chapel also underwent some reorganisation around this time. The depiction of an image niche and altar squint indicates that formerly a side altar, or more probably a chantry foundation, had been present, and may further suggest direct lay involvement in the second half of the fourteenth century (see Figure 5.2). The drawings also show that the walls of both the south and north aisles of the chapel had new windows fitted during the later fourteenth or early fifteenth century. This was evident too from the excavations, which revealed that the exterior, primarily flint-​faced, south aisle wall was reconstructed with dressed ashlar at this time.

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Inside the south aisle of the chapel, excavations uncovered a series of burials (nine graves containing eleven individuals). These included a plaster-​ lined tomb, with the remnants of a Purbeck marble slab, the contents of which had been ‘robbed’ subsequent to burial. Out of the eleven burials, seven were either old or mature adults, and only two individuals, where an assessment of sex could be made, were not adult males, one of these being a mature adult female and one a young female child. Only one burial had evidence of leprosy, but this is possibly residual and may have been an earlier burial disturbed by later grave-​digging. The remains within the earliest of these graves have been radiocarbon dated to the later fourteenth century. This evidence, combined with their location and the preponderance of older individuals among this group, may suggest that these were patrons of the institution rather than residents. There is also evidence from wills and bequests, noted above, that show patronage and a direct interest in the institution by lay testators. Taken together, the evidence from wills, bequests and the burials may be indicative of a refoundation around the mid-​ fourteenth century and may further indicate the renewed status of the hospital as one worthy of sponsorship and a site of intercessory prayer. The support of lay patrons and their relationship with Saint Mary Magdalen through arrangements for burial and intercession would suggest the integration of the hospital with the society of Winchester and the wider area at this time. Thus both the documentary and archaeological evidence indicate that the hospital was in relatively good order towards the end of the fourteenth century. It is likely, however, that by this point Saint Mary Magdalen had ceased to function purely as a leprosarium, a pattern of change noted elsewhere and considered above. The references to various brothers, sisters, clerks and masters at the hospital in this period suggest an institution that was more outward-​looking and more in touch with Winchester ecclesiastical society, links that would have been appropriate for a Maison Dieu, even though they also befitted a leprosy house. Some of the clergy and brethren at Saint Mary Magdalen are mentioned in documents by name, such as William Chaloner and Roger Muleward, and the unfortunate Adam Coudrich, collated to the hospital in 1369 by Bishop William Wykeham (1366–​ 1404). Coudrich is described

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as ‘aged, weak, poverty stricken; and unable with his own hands to gain a maintenance’.64 This reference is particularly intriguing, since it indicates that by this time the hospital was catering for the poor and needy more generally, not just leprosy sufferers. This would tally perhaps with the wider evidence for the decline in leprosy at this period, and indicate that former leprosy hospitals were adapting to changing circumstances. Earlier on in his ecclesiastical career Bishop Wykeham was master of the hospital, and seems to have taken a longstanding interest in the institution’s welfare, leaving an endowment to it in his will. In 1400, Wykeham initiated a full inspection of Saint Mary Magdalen in terms of its buildings, residents and financial undertakings. The information from the inventory of 1400 provides a unique insight into the financial health and administration of the hospital. It received various revenues, including £25 19s 4d from the treasurer of the bishop’s palace at Wolvesey in Winchester.65 At this time the institution had six residents living in separate houses, and ten still living communally.66 This may further imply some structural reorganisation in the second half of the fourteenth century. Clearly the hospital was, institutionally, moving towards becoming an almshouse in terms of offering individual accommodation. Wykeham’s inventory also has something to say concerning the resources of the hospital. It records 14 acres of land and pasturage for 101 sheep, as well as the arrangements for oblations and offerings received, which were to go towards the fabric or to be divided amongst the residents. A significant list of ornaments for the chapel is also cited. These included chalices, crosses, vestments, a missal worth 100s and a beautiful green tapestry or carpet described as ‘powdered with birds and roses’.67 The ornaments and decorations were comparable with those found in many medieval chapels and parish churches of the period. The hospital also continued to own town property through the fifteenth century. In 1417 it was landlord of a tenement of eight cottages and a garden in the city,68 and in 1463 it owned a tenement in nearby Water Lane.69 At the beginning of the fifteenth century a tenement was granted to the hospital by a clerk, William Atkynson, who later became Master of Saint Mary Magdalen.70 A 1420 bequest by John Fromond, steward of Winchester College,

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states: ‘Lego ad distribuendum inter leprosos B. Marie Magdalene, Wynton, …’ (‘I bequeath to be distributed among the leprosi of Saint Mary Magdalen, Winchester …’),71 which indicates that leprosy sufferers (although we do not know how many) did still reside at the hospital by this time. Archaeological evidence for the hospital in the fourteenth and fifteenth centuries above all consists of the addition of a building attached to the south aisle of the infirmary. The foundations of this building mainly comprised flint with chalk and reused stone. Internally, it contained a centrally placed tiled hearth with associated floor deposits and late medieval pottery. This structure may represent an earlier Master’s or Warden’s Lodge. It is possible that a north aisle, or cloister south range, was constructed to the north of the infirmary during this period, together with a passageway running north to south (possibly forming an eastern range), giving access to a series of large pits, or middens, and a small stone-​lined latrine, towards the north and downslope of the infirmary. These pits yielded material mainly from the fourteenth century onwards, and the whole ‘claustral’ complex may relate to the ‘refoundation’ of the hospital at this time. One general omission from the material record of medieval hospitals concerns objects relating to medical care and practice. What many of these sites yield, however, are objects relating to reading and writing, which might otherwise be found on monastic sites. Such materials may represent ‘medieval provision [for the sick] of a kind’, since literacy and the production of books were vital to the transmission of medical knowledge.72 At Saint Mary Magdalen, Winchester, such finds included a medieval parchment pricker and hone, or sharpening, stones. Other items, from various phases of the hospital, included a range of metal objects such as spoons, knives and blades, scissors, pins, and tweezers, all of which could have had medical as well as personal functions. The medieval pottery from the middens comprised a range of objects, including cooking pots, storage vessels and jugs. In particular the material from the late medieval contexts was of a reasonably good standard, though the majority of it appeared to have been sourced locally or regionally rather than through long-​distance  trade.

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From hospital to almshouse, c. 1500–​1600 Manorial accounts from the bishopric Pipe Rolls for building work at the bishop of Winchester’s palace at Marwell, Hampshire, reveal that in 1496–​97 Bishop Langton had the following sent to the ‘hospital of the blessed Mary Magdalene’: 19 carts of timber, 30 carts of tiles and 162 carts of bricks.73 This is a substantial amount of building material and implies a major programme of construction at the hospital, a point supported by excavations that revealed that the infirmary was converted to an almshouse at this time. The excavations demonstrated that although the medieval plan of the hospital was still largely adhered to, and the medieval chapel was largely unaltered, the infirmary building was structurally reorganised and extended. The bricks from Marwell were used to construct internal brick walls that divided the former infirmary hall into individual ‘houses’, with internal corridors and brick fireplaces on the back walls (see Figures 5.7 and 5.8). The hall was rebuilt to the west, and evidence of a large hearth or fireplace, and its proximity to the well, suggest that this area was used as a communal kitchen or refectory. The attached masonry master’s lodge to the south was rebuilt, again mostly in brick, and extended to join the medieval chapel to its south. This building had evidence of internal partitions, a fireplace and joist beam slots for a boarded floor. To the east of the building was an adjunct brick-​lined and tiled latrine. A  small and tiled passageway was also constructed to the west of the lodge to provide direct access to the chapel. The northern ‘cloister’ was also dismantled and converted to an open yard, although the area still continued to be used for general waste management. Saint Mary Magdalen, like some other contemporary hospitals, appears to have escaped official dissolution in the 1530s, possibly because of its new status as an almshouse, and it was still receiving endowments in the sixteenth century, including the gift of another tenement at Water Lane in 1569.74 In 1535, the Valor ecclesiasticus recorded for the hospital a reasonably healthy gross income of £42 16s. This had changed little in 1545, when the chantry certificate valued the hospital at £41 6s 8d, £19 7s 4d of which was divided among ‘nine poor men and women’.75 Thus the size

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of the community had significantly contracted, but the number of residents does reflect the capacity of the almshouse based on the excavation of the individual ‘houses’. Some years later, in the 1580s, the community still numbered nine individuals (including a master). That the institution was still operating during the sixteenth century is also supported by an appeal of 1552 from the master to the Court of Augmentations of Edward VI. The appeal concerned a stipend of £6 for the funding of a priest to minister in the hospital. This stipend went to the king in accordance with the 1547 Act for the Dissolution of Chantries. However, the master argued that it was used legitimately to administer sacraments to the ‘poor’ of the hospital. The appeal was successful, since the Court granted the money back to the master and his successors.76 This direct relationship between the hospital and almshouse phases suggests some level of continuity throughout the later medieval period and the Reformation. Certainly the continuity of documentary records over the period, as noted above, implies that there was no formal institutional break. Finally, a brief summary of the hospital’s quietus after the sixteenth century will set this chapter in a wider historical context. From the 1640s Saint Mary Magdalen was affected by a series of events. In 1643 Royalist troops ‘plundered its barns, stole and killed its sheep, burned all the woodwork they could find and turned the chapel into a stable for their horses’.77 The hospital experienced even worse problems in 1665, when Charles II seized it for the confinement of Dutch prisoners of war. Their arrival meant the removal of the residents and master from the site. They were never to return, and probably decamped to new lodgings in the city, at Colebrook Street. The Dutch prisoners gutted both the houses and the chapel, removing all the remaining wood for fuel; stripping the iron, brass and lead from the chimneys; and the bell, wainscot and communion table from the chapel.78 The hospital was ruined and the Government offered only £100 to rebuild it, a sixth of the sum required.79 The excavations revealed evidence of this phase of activity mainly through deposits of prison rubbish spread around the site, which consisted mostly of animal bones, clay pipes and broken bottles. Part of a circuit wall was also excavated and may be evidence of a prison enclosure in the 1660s.

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By 1788 the remaining buildings were ruinous, being described by the contemporary master, Philip Baker, as consisting of parts of the master’s house, the shell of the chapel, part of the barn, a well house, and ‘chiefly old foundations and [a?] flint tyled wall’.80 Baker petitioned the bishop of Winchester to dismantle the ruins, which were then being used as a ‘magazine for fairs and camps’. The site was visited by six commissioners who advised that it should be demolished. The bishop duly gave permission, and in 1789 the remaining buildings were systematically dismantled, much of the building materials being used to construct new almshouses at Water Lane at the bottom of the hill.81

Conclusion This chapter has presented a multidisciplinary and contextual case study of one of Britain’s earliest excavated leprosy hospitals. Past research on British medieval leprosy hospitals has been hampered by both the limited availability and accessibility of the archaeological evidence, and limited documentation, particularly prior to the twelfth century. At Winchester, the comparatively high standard of archaeological preservation, coupled with a reasonable body of later documentary and architectural evidence, has presented a valuable opportunity to examine an early leprosarium and the identities of those who lived there. Recent years have witnessed a reassessment of the medieval evidence and a questioning of the identity of the ‘medieval leper’ as an outcast.82 The evidence from Winchester, when placed into this context, further challenges these long-​held assumptions and suggests a wholly different picture. As we have seen, in the late eleventh and early twelfth century Saint Mary Magdalen, Winchester, consisted of a small chapel, simple accommodation and a well-​ordered cemetery, very much like a small religious establishment. The individuals buried in the cemetery were a mixed demographic with a very high frequency of leprosy. The graves were systematically cut and anthropomorphically shaped, and probably marked, suggesting overall that the dead here were treated with a high level of dignity and respect. At Saint Mary Magdalen, both the spiritual and physical needs of the community were catered for. Overall, this evidence supplies a more progressive,

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positive picture of the identity and social status of Winchester’s leprosy sufferers, at least in the earlier medieval period. In this light, we can argue that the first British leprosaria of the late eleventh and early twelfth century were religious communities  –​ with the chapel and cemetery as places of communal worship and commemoration –​rather than segregated communities of outcasts. However, it is likely that such a situation was relatively short-​ lived, and that as the disease continued to spread during the later twelfth and thirteenth century, coupled with a growing awareness of disease transmission and contagion, these early communities morphed into more formal, demarcated institutions. This shift may have coincided with the development of more clearly defined and more explicit (and explanatory) Church legislation. By the 1180s at Winchester, the simple timber buildings, chapel and cemetery had been replaced by masonry buildings, indicative of a more rigidly organised arrangement. This included a large masonry infirmary and a cloister. It was also a period when the hospital began to appear more prominently in the historical records. Overall the excavations at Saint Mary Magdalen, Winchester, have shed important light on the form and function of early leprosy hospitals, how they were integrated or segregated with respect to broader society, and the precise pathology of those buried within them, as well as enabling an investigation into the development of a medieval hospital over time and the fortunes of such medieval institutions in the immediate post-​ Reformation period. Work at Winchester has contributed to a growing body of historical and archaeological research that is increasing our understanding of medieval leprosy and its materiality, and has added to our appreciation of the identities of leprosy sufferers  –​identities that have for too long been lost within the shadows of prejudice and misunderstanding.

Notes 1 Although no architectural structures were found, excavations took place in the 1980s and 1990s at the leprosarium cemetery at Chichester:  J. Magilton, F. Lee and A. Boylston (eds), ‘Lepers outside the Gate’:  Excavations at the Cemetery of the Hospital of

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St James and St Mary Magdalene, Chichester, 1986–​1987 and 1993 (York: Council for British Archaeology, 2008). In France, important excavations occurred at the cemetery and leprosy hospital at Aizier, Normandy, between 1998 and 2010:  see C. Niel and M.-​C. Truc (with B. Penna), ‘La Chapelle Saint-​Thomas d’Aizier (Eure): Premiers résultats de six années de fouille programmée’, in B. Tabuteau (ed.), ‘Etude des lépreux et des léproseries au Moyen Age dans le nord de la France: Histoire –​archéologie –​patrimoine’, Histoire médiévale et archéologie, 20 (2007), 47–​107; http://​w3.unicaen.fr/​ufr/​histoire/​ craham/​spip.php?article120&lang=fr (accessed 24 June 2013). 2 The terms ‘leprosy sufferer’ or ‘leprosy hospital’ are here used instead of the traditional and less cumbersome ‘leper’ and ‘leper hospital’ (as used, for example, previously by myself in S. Roffey, ‘Medieval leper hospitals in England:  An archaeological perspective’, Medieval Archaeology, 56 (2012), 203–​33). Leprosy, now known as Hansen’s disease, still affects millions of people around the world today and the term ‘leper’ has become a pejorative term with much stigma attached. For several decades leprosy sufferers and charities, such as Lepra and UK Leprosy Mission, have campaigned for the term not to be used, seeing it as ‘a word that is derogatory, outdated, and is associated with someone who has been rejected, ostracised or regarded as an outcast’. This chapter will respect their wishes. For more information see www.leprosymission.org.uk/​take-​action/​dont-​call-​me-​a-​leper.aspx (accessed 30 May 2019). 3 For the purpose of clarity this chapter will define such communities as leprosaria, as distinct from the term ‘hospital’, which speaks of a more formal and institutionalised, and often later, arrangement. These later arrangements may reflect a change in attitude towards the disease, as discussed in C.  Rawcliffe, Chapter  4 in the present volume. 4 G. Robbins, V. Mushrif Tripathy, V. N. Misra et al., ‘Ancient skeletal evidence for leprosy in India (2000 B.C.)’, PLoS One, 4 (2009), e5669. 5 R. Reader, ‘New evidence for the antiquity of leprosy in early Britain’, Journal of Archaeological Science, 1 (1974), 205–​8. 6 T. A. Mendum, V. J. Schuenemann, S. Roffey et al., ‘Mycobacterium leprae genomes from a British medieval leprosy hospital:  Towards understanding an ancient epidemic’, BMC Genomics, 15 (2014), 270, www.biomedcentral.com/​1471–​2164/​15/​270 (accessed 14 October 2020); G. M. Taylor, K. Tucker, R. Butler et  al., ‘Detection and strain typing of ancient Mycobacterium leprae from a medieval leprosy hospital’, PLoS One, 8 (2013), e62406, DOI: 10.1371/​journal. pone.0062406.

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7 See discussion of the decline of leprosy in the Introduction to this volume, pp. 4–5. 8 E. J. Kealey, Medieval Medicus:  A Social History of Anglo-​Norman Medicine (Baltimore: Johns Hopkins University Press, 1981), pp. 85–​7. 9 Eadmer, Eadmer’s History of Recent Events in England, ed. and trans. Geoffrey Bosanquet (London: Cresset Press, 1964), pp. 16–​17. 10 M. Hicks and A. Hicks, St Gregory’s Priory, Northgate, Canterbury Excavations 1988–​1991, Vol. II (Canterbury: Canterbury Archaeological Trust, 2001). 11 See S. Roffey, ‘Charity and Conquest:  Leprosaria in early Norman England’ in D. M. Hadley and C. Dyer (eds), The Archaeology of the Eleventh Century:  Continuities and Transformations (London: Routledge, 2017), pp. 159–​76. See also Rawcliffe, Chapter 4 in the present volume. 12 Saint Benedict, ‘The Rule of St Benedict’, ed. and trans. David Oswald Hunter Blair (Fort Augustus: Abbey Press, 1948), Chapter 36. 13 M. A. D’Aronco, ‘The Benedictine Rule and the Care of the Sick: The Plan of St Gall and Anglo-​Saxon England’, in B. S. Bowers (ed.), The Medieval Hospital and Medical Practice (Aldershot:  Ashgate, 2007), pp. 235–​51. 14 E. Brenner, ‘Outside the city walls:  Leprosy, exclusion, and social identity in twelfth-​and thirteenth-​century Rouen’, in M. Cohen and J. Firnhaber-​Baker (eds), Difference and Identity in Francia and Medieval France (Aldershot: Ashgate, 2010), pp. 139–​55 (p. 142). 15 See E. Brenner, ‘The care of the sick and needy in twelfth-​and thirteenth-​century Rouen’, in L. V. Hicks and E. Brenner (eds), Society and Culture in Medieval Rouen, 911–​1300, Studies in the Early Middle Ages, 39 (Turnhout: Brepols, 2013), pp. 339–​67 (p. 344). 16 C. Lee, ‘Changing faces:  Leprosy in Anglo-​ Saxon England,’ in C. Karkov and N. Howe (eds), Conversion and Colonization in Anglo-​ Saxon England (Tempe: Arizona Center for Medieval and Renaissance Studies, 2006): pp. 59–​81 (p. 76). 17 E. Shepherd Popescu, Norwich Castle:  Excavations and Historical Survey 1987–​98, Part I: Anglo-​Saxon to c. 1345 (Dereham: Historic Environment, Norfolk Museums and Archaeology Service, 2009), p. 132. 18 Ibid., p. 270. 19 Roffey, ‘Medieval leper hospitals in England’. 20 Eadmer, Eadmer’s History of Recent Events in England, pp. 16–​17. 21 D. W. Hall, ‘Archaeological excavations at St Nicholas Farm, St Andrews, Fife, 1986–​87’, Tayside and Fife Archaeological Journal, 1 (1995), 48–​76.

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22 R. Atkins and E. Popescu, ‘Excavations at the hospital of St Mary Magdalen, Partney, Lincolnshire, 2003’, Medieval Archaeology, 54 (2010), 207–​70; C. Crossan, J. Cooper, N, Crummy et al., ‘Excavations at St Mary Magdalene’s Hospital, Brook Street, Colchester’, Essex Archaeology and History, 34 (2004) 91–​154; A. B. Powell, ‘A possible site for the hospital of St John the Baptist and St Anthony at Old Sarum, Salisbury’, Wiltshire Archaeological & Natural History Magazine, Wiltshire Studies, 99 (2006), 213–​20. 23 N. Orme and M. E.  G. Webster, The English Hospital 1070–​1570 (New Haven: Yale University Press, 1995), p. 41. 24 C. Thomas, B. Sloane and C. Phillpotts, Excavations at the Priory and Hospital of St Mary Spital, London (London:  Museum of London Archaeology Service, 1997); R. Price and M. Ponsford, St  Bartholomew’s Hospital, Bristol:  The Excavation of a Medieval Hospital, 1976–​8, CBA Research Report, 11 (York: Council for British Archaeology, 1998). 25 M. Farley and K. Manchester, ‘The cemetery of the leper hospital of St Margaret, High Wycombe, Buckinghamshire’, Medieval Archaeology, 33 (1989), 82–​9. 26 C. Wells, ‘A leper cemetery at South Acre, Norfolk’, Medieval Archaeology, 11 (1967), 242–​8. See Roffey, ‘Medieval leper hospitals in England’, for a more detailed overview of excavated cemetery sites. 27 Magilton, Lee and Boylston, ‘Lepers Outside the Gate’. 28 S. Roffey and P. Marter, ‘Excavations at the medieval leprosy hospital of St Mary Magdalen, Winchester, 2008–​2013’, Church Archaeology, 16 (2014), 39–​44. 29 R. M. Clay, The Mediaeval Hospitals of England (London: Meuthen, 1909), p. 106; Eadmer, Eadmer’s History of Recent Events in England, pp. 16–​17. 30 Vetusta monumenta, Vol. III (London: Society of Antiquaries, 1796). 31 Ibid., pp. 1–​17. 32 I.e. Victoria County History (VCH), Victoria County History of Hampshire, Vol. II (London: HMSO, 1973). 33 T. Beaumont James, English Heritage Book of Winchester, 2nd edn (London: Batsford, 2007); D. Keene, Survey of Medieval Winchester, Winchester Studies, 2 (Oxford: Oxford University Press, 1985), p. 19. However, as we shall see, the archaeological evidence places the origins of the hospital at least a century earlier, and probably pre-​dating this chapel. 34 B. Carpenter Turner, A History of Winchester (Chichester: Phillimore, 1992), p. 16. 35 Vetusta monumenta, Vol. III, pp. 1–​17. 36 Keene, Survey, p. 201.

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37 Carpenter Turner, A History, p. 17. 38 Eadmer, Eadmer’s History of Recent Events in England, pp. 16–​17. 39 S. Roffey and K. Tucker, ‘A contextual study of the medieval hospital and cemetery of St Mary Magdalen, Winchester, England’, International Journal of Paleopathology 2(4) (2012), 170–​80. 40 Roffey, ‘Medieval leper hospitals in England’, p. 221. 41 D. J. Ortner, ‘Skeletal manifestations of leprosy,’ in Magilton, Lee and Boylston, Lepers outside the Gate pp. 198–​207 (pp. 199–​200). 42 Shepherd Popescu, Norwich Castle. 43 Roffey, ‘Medieval leper hospitals in England’, p. 211. 44 The ceramics for this period in general cannot often be ascribed to either a late Anglo-​Saxon or early Norman provenance. 45 Roffey and Tucker, ‘Contextual study’, p. 175. 46 S. Roffey, K. Tucker, K. Filipek-​ Ogden et  al., ‘Investigation of a medieval pilgrim burial excavated from the leprosarium of St Mary Magdalen Winchester, UK’, PLoS Neglected Tropical Diseases, 11(1) (2017),  1–​27. 47 P. Yeoman, Pilgrimage in Medieval Scotland (London:  Batsford/​ Historic Scotland 1999), p. 116. 48 Roffey, ‘Medieval leper hospitals in England’, p. 221. 49 On leprous pilgrims to Thomas Becket’s shrine at Canterbury, see D. Jeanne, Chapter 3 in this volume. 50 Carpenter Turner, History of Winchester, p. 17. 51 Thomas Wharton, The History and Antiquities of Winchester (Winchester: J. Wilkes, 1773), p. 200. 52 VCH, Hampshire, p. 197. 53 Ibid. 54 Presumably Winchester Cathedral. 55 See discussion of the sum of £25 19s 4d on p. 138 above. 56 VCH, Hampshire, p. 197. 57 Ibid. 58 Ibid., p. 198. 59 B. B. Woodward, A History and Description of Winchester, facsimile of the edition of 1860 (Alresford: Laurence Oxley, 1974), p. 243. 60 Keene, Survey, p. 231. 61 Ibid., p. 668. 62 Ibid., p. 589. 63 Orme and Webster, The English Hospital, p. 127. 64 VCH, Hampshire, p. 198. 65 The disbursement of the sum of £25 19s 4d from the bishop’s funds corroborates the notion that the same sum was originally granted by the bishop of Winchester in the twelfth century: see p. 138 above. 66 VCH, Hampshire, p. 199.

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67 Ibid. 68 Keene, Survey, p. 201. 69 Ibid. 70 Ibid., p. 1072. 71 VCH, Hampshire, pp. 108–​9. 72 G. Egan, ‘Material culture of care for the sick:  Some excavated evidence from English medieval hospitals and other sites’, in Bowers, The Medieval Hospital, p. 66. 73 Winchester, Hampshire Record Office (HRO), 11M59 B1/​214. I  am grateful to Dr John Hare for drawing my attention to this source. 74 Keene, Survey, p. 1050. 75 VCH, Hampshire, p. 200. 76 HRO, 51M48/​2/​2. 77 Wharton, The History and Antiquities, p. 202. 78 HRO, 21M65/​32/​2/​2/​1. 79 VCH, Hampshire, p. 200. 80 HRO, 21M65/​32/​2/​2/​1. 81 HRO, 21M65/​32/​2/​2/​4. 82 For example, see in the present volume F.-O. Touati, Chapter 2, and Rawcliffe, Chapter 4.

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Diet as a marker of identity in the leprosy hospitals of medieval northern France Elma Brenner Food and drink were key markers of status in medieval Europe, with different dietary options available to urban and rural dwellers, as well as to members of aristocratic households, religious communities, armies and other groupings.1 Diet  also affected health. As is the case today, malnutrition made people vulnerable to epidemic and chronic illnesses, and contaminated food and drink were associated with sickness.2 At the same time, physicians held that dietary regulation was a key means of remaining healthy, and advised the consumption of specific foodstuffs or combinations of food to bring about recovery from specific ailments. This chapter considers the significance of food and drink with respect to leprosy in northern France between the twelfth and fifteenth centuries, focusing especially on the experiences of people with leprosy as members of hospital communities. Attention is paid above all to the north-​western region of Normandy, for which rich documentary sources survive, and further material is drawn from other areas, particularly the Pas-​de-​Calais region. Numerous leprosaria were founded in northern France from the early twelfth century, and the area was also highly prominent in the production and trade of food and wine in the Middle Ages, making it an appropriate focus for this study. Much of the significance of food and drink within leprosy hospitals stemmed from the fact that these were monastic or quasi-​ monastic Christian institutions where charity was offered to the sick.3 Giving food to the hungry and drink to the thirsty were two of the biblical works of mercy, charitable acts that medieval Christians needed to fulfil in order to ensure their own future salvation. The fact that people with leprosy required essential sustenance thus

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enabled the benefactors who supplied them with food and drink to accomplish charitable works. Indeed, in the majority of leprosy hospitals, dietary provision was more reflective of hospitality, which also entailed the supplying of shelter, warmth and clothing, than of intervention by medical practitioners. Yet while leprosy hospitals did not usually call upon the services of physicians, surgeons or apothecaries, the lay brothers and sisters who tended to the leprous developed considerable expertise regarding the care of these patients, including knowledge about how to provide the most appropriate diet for them. Furthermore, in leprosaria, as in all monastic communities, collective dining was an essential group activity that brought the community together, arguably promoting the wellbeing of residents through social interaction. Indeed, sociologists argue that food and drink play an important role in the formation and consolidation of group identities, as well as acting alongside other factors, such as professional occupation and religion, to shape the identities of individuals.4 Echoing biblical meals, especially the Last Supper, meals also had devotional significance within leprosaria, as moments of prayer and thanksgiving, particularly on the occasion of religious feasts. Nonetheless, meals at leprosaria were not necessarily always sociable gatherings, especially when silence was enforced. While leprosaria were a focus of charitable donations, especially in the twelfth and thirteenth centuries, leprosy patients themselves needed to fulfil certain criteria in order to be admitted to some of these communities, especially the larger leprosaria. Entry was often restricted to those who were born or resided within certain parishes in the locality, and who were able to offer an entrance gift upon their admittance. Yet there were still multiple distinctions of social and religious status within leprosy hospitals, distinctions that were often underlined through the provision of food and drink. The diet of the non-​leprous residents of these communities sometimes distinguished them from the sick, and also varied according to status. The practical arrangements surrounding meals, from communal eating to ownership of eating utensils, were important signifiers of status and identity. Issues of contamination and contagion came into play in certain instances, with the leprous being prohibited from eating with the non-​leprous and from touching the food and utensils of the latter.

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The consumption of food and drink by the sick within leprosaria was undoubtedly affected by the symptoms of leprosy. The physical and sensory damage caused by the disease, described by Charlotte Roberts in the opening chapter of this volume,5 would have affected the sufferer’s capacity to eat and drink. Degeneration of the palate would have made it difficult to ingest solids and fluids, as would facial paralysis resulting from nerve damage. Frequently sufferers lost many of their teeth, as shown in skeletons excavated from the cemetery of the leprosarium at Aizier in Upper Normandy, making it harder to chew food.6 Damage to the hands and eyesight created additional challenges with regard to availing oneself of food and drink. Furthermore, the senses of taste and smell can be altered by the disease, having an impact upon appetite. The inclusion of soft, easily digestible foodstuffs such as eggs and freshly baked bread within the dietary regimen for the sick at leprosy hospitals in Normandy and northern France may reflect these physical and sensory considerations, although, as this chapter will demonstrate, other factors also came into play in the provision of food and drink within leprosaria.

Medical thinking and advice Diet had an important place in the thinking of medieval physicians and surgeons regarding the causes and treatment of leprosy, as it did for understandings of health and illness more broadly. While scholarly ideas about leprosy and diet may not have directly influenced the regimen within leprosaria, we do know that by the end of the Middle Ages learned medicine reached increasingly broad audiences in the form of advice literature.7 In ancient and medieval medicine, diet was one of the non-​naturals:  variable factors that were held to influence health in either beneficial or detrimental ways. It was understood that the regulation of the diet, by preserving or restoring the balance of the four bodily humours, would enable an individual to maintain or improve their health. Similarly, certain foodstuffs, especially when consumed excessively, created an imbalance in the humours and caused ill health. Particularly before the Black Death, after which point factors outside the body, above all corrupt air, were increasingly understood to transmit disease,

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leprosy was attributed to internal bodily corruption, brought about by an imbalance of the humours with a preponderance of the melancholic humour. Logically, medieval authors cited melancholic foods, such as lentils and donkey meat, as causes of leprosy. However, foods with other humoral qualities, such as phlegmatic meat, were also seen as problematic, as were certain foods and drinks in combination with each other, and certain qualities (such as saltiness and coarseness) of foods of any kind.8 The surgeon Henri de Mondeville (d. soon after 1316), who originated from Normandy and taught at the University of Montpellier, included among the causes of leprosy not only ‘prolonged use of melancholic foods’ but also the consumption of milk and fish simultaneously, or milk and wine.9 Contaminated food was also viewed as a cause, and it is no coincidence that a set of statutes issued in 1432 governing the sale of meat at two new butcheries in Rouen, Normandy’s chief city, prohibited the sale of beef, pork or lamb infected with any kind of disease.10 Leprosy was also, albeit less frequently, linked to under-​ nourishment. Henri de Mondeville argued that: ‘The diet prescribed for all malnourished persons is good for lepers.’11 By the later Middle Ages, a deficient diet was linked to epidemic illness, since it was understood that a malnourished body was more susceptible to absorbing miasmatic air than a well-​nourished body.12 While a poor or deficient diet was not necessarily seen as a cause of leprosy, it is likely that under-​nourishment was observed in those who had developed the symptoms of the disease. A study of leprosy patients at a hospital in Delhi, India, published in 2012, identified under-​ nourishment in a significant number of those people examined, especially women and those who had become disabled as a result of leprosy. The authors of this study argued that there were a number of reasons for this, including the socio-​economic ramifications of stigma, the fact that disabled individuals were less able to earn a living, and the impact of depression caused by leprosy upon appetite.13 While medieval physicians and surgeons did not consider it possible to heal leprosy, since they held that the whole body became corrupted and the corruption could thus not be isolated and removed, they did believe that the disease’s symptoms could be alleviated by restoring the humoral balance, through evacuation

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(bloodletting, purging) and dietary regulation. To combat the sickness, Henri de Mondeville recommended cool, moist foods. Nonetheless, he observed that each sufferer had their own personal humoral complexion, meaning that treatment needed to be tailored towards the specific requirements of the individual.14 Other learned authors offered similar advice, recommending that the leprous should consume moist, mild food and drink, such as poultry, eggs, fresh fish, freshly baked bread, good-​quality pork and light wine.15 Medical advice regarding leprosy was also available in more popular texts. A  vernacular printed text that circulated widely in France in the late fifteenth and sixteenth centuries, the Traité des eaux artificielles (Treatise of Artificial Waters), included several plant-​, mineral-​and animal-​based liquid remedies to alleviate or cure the symptoms of leprosy, alongside distilled liquids for other medicinal as well as cosmetic purposes.16 In one version of the text printed in Normandy, probably by a Rouen printer c. 1525–​50, for Michel Angier, bookseller of the University of Caen, a distillation formed from the bugloss plant is recommended to counter the effects of melancholy, and is said to cure leprosy and another skin complaint, rongne (scabies).17 It was presumably intended that this medicinal water should be drunk, although there was also the potential for it to be applied to the skin. The only known extant copy of this printing has annotations by an early reader, confirming that the text was considered useful in the sixteenth century.18

Community life and status Information about dietary arrangements within leprosy hospitals in Normandy and other areas of northern France is derived from a range of documents, including charters; statutes describing the ideal way of life in these communities; and episcopal visitation records recording, albeit from a specific viewpoint, what was happening on the ground. Leprosarium statutes frequently detail the food and drink to be given to the sick, as well as to other members of the resident community. In practical terms, diet was an essential aspect of community life that needed to be set down in such documents, regardless of the specific alimentary needs of the sick. Nonetheless,

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detailed arrangements regarding food and drink do show an awareness that providing adequate sustenance and, sometimes, regulating the diet, were an essential aspect of the bodily care of the leprous. Dietary measures sat alongside other aspects of care, including bloodletting, bathing, physical exercise and exposure to a beneficial environment, as well as the care of the soul. Eudes Rigaud, archbishop of Rouen (1248–​75) issued statutes for the female leprosarium of Salle-​aux-​Puelles outside Rouen in August 1249. The statutes are written down in the manuscript volume recording his visitations of monasteries, hospitals, leprosaria and parish churches in his archdiocese between 1248 and 1269.19 Salle-​aux-​Puelles was a high-​status house, endowed by King Henry II of England, the residents of which are traditionally held to have been of aristocratic status. The community followed a religious way of life, although the specific monastic order adopted by the women is not known.20 Eudes Rigaud’s statutes provide us with valuable information about arrangements for leprous women, whose experiences are not documented as extensively as those of leprous men in the present volume.21 The statutes stipulate that the leprous sisters are to have beer, wine and bread daily, fresh meat in the proper season, fish once a week at other times, and five eggs or three herring on days when they do not eat other fish or meat. Indeed, they are to abstain from eating meat during Lent and on solemn feast days.22 The diet at Salle-​aux-​Puelles aligns with that recommended by learned physicians and surgeons for leprosy sufferers, in terms of the consumption of fresh, mild and moist foodstuffs. Wine was a staple drink that was consumed at many other northern French leprosaria.23 However, the statutes also prescribed that the non-​ leprous clerics residing at Salle-​aux-​Puelles should enjoy exactly the same diet, unless a change needed to be made for a reason such as the offering of hospitality to guests, when presumably more elaborate meals could be prepared for the clerics and their guests.24 This could suggest that these tenets were primarily aimed at regulating the monastic way of life at Salle-​aux-​Puelles, rather than at instituting a regimen for leprosy sufferers, especially since apparently no consideration was made of the implications of dietary abstinence for the sick women.25 Indeed, the diet is reminiscent of that at other religious communities that accommodated women of

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elevated social status. At Lacock Abbey, Wiltshire, in 1347–​48, for example, the nuns consumed beef, chicken, eggs, wheat and herring, alongside more luxurious foods such as veal, which was not necessarily available at Salle-​aux-​Puelles.26 The diet enjoyed by the sick within leprosy hospitals varied according to both the material circumstances of the leprosarium in question, and the social and religious identities of the leprous residents. At the small leprosarium at Gournay-​en-​Bray, east of Rouen, there was a shortage of the basic necessities of life in the 1260s. Enquiring into the condition of the community on 5 March 1259 (= 1260),27 Archbishop Rigaud learnt that ‘they did not have wheat to eat or oats to sow’.28 Four-​and-​a-​half years later, on 18 October 1264, the archbishop spoke with the masters and procurators of the same leprosarium, who informed him that the community had few provisions to sustain it for the rest of the year. At this time there were six leprous men and women, seven non-​leprous lay-​men and -​women, and a small number of staff in residence.29 The larger leprosy hospitals, such as Salle-​ aux-​ Puelles and Rouen’s other major leprosarium, the Augustinian community of Mont-​aux-​Malades, could draw upon agricultural produce from their landed estates, as well as endowments in kind, to feed the resident community. Mont-​aux-​Malades, for example, grazed pigs in the forest of Lyon and had a rich supply of herring from the Normandy coast through the gifts of King Henry II of England.30 Herring, also seen in the diet at Salle-​aux-​Puelles, are relatively easy to ingest; the health benefits of this oily fish, which is a source of Vitamin D, are certainly recognised today.31 Within the larger communities, a number of distinctions were made regarding diet, causing food and drink to become markers of status and identity. For example, at Mont-​aux-​Malades, where leprous men and women lived alongside Augustinian canons and lay brothers and sisters, religious from other monastic houses who entered the community because they had contracted leprosy apparently enjoyed a different diet from that of the other leprous residents. When a leprous brother, Canon Roger, and a leprous sister, Haisia, from Rouen’s La Madeleine hospital (also an Augustinian community) entered Mont-​aux-​Malades in October 1261, the prior of La Madeleine made arrangements regarding their diet, offering

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to finance their sustenance. Canon Roger was to have the same entitlement to food and drink as a brother of Mont-​aux-​Malades, and Sister Haisia was to have the same victuals as a sister.32 While it is possible that these arrangements referred to the diet of the leprous brothers and sisters, it is also plausible that the religious of La Madeleine were to enjoy the provisions offered to non-​leprous members of the community at Mont-​aux-​Malades (for Roger, the diet of a canon or a lay brother; for Haisia, that of a lay sister). If so, the different resident groups at the leprosarium had different allocations of food and drink. Special dietary arrangements were also made for leprous monks from the Benedictine abbey of Saint-​ Ouen, Rouen’s largest monastery, at Mont-​ aux-​ Malades. A  charter issued by the leprosarium’s prior on 18 February 1296 (= 1297) resolved a dispute between the leprosarium and the abbey, suggesting that contention had arisen over the entitlements to be received by the monks. The charter established that a monk from Saint-​Ouen was to receive bread and wine daily, paid for by the abbey, and to have a diet of meat (fresh and salted), eggs and herring. He was to enjoy a pittance (special allowance) of meat, fish or wine whenever the canons of Mont-​aux-​Malades did, as if he was one of them (my emphasis).33 Again, a specification was made regarding payment for food and drink by the ‘home’ community of the religious, revealing that it was important to settle this matter. Here, leprous religious from another monastic house were unequivocally aligned with the healthy religious of Mont-​aux-​Malades, rather than with the leprous residents. Furthermore, the monks of Saint-​Ouen were aligned with the leprosarium’s canons, not the lay brothers, confirming their elevated status. The charter also describes the dietary allowance of the monks’ servants, revealing another dimension of their special entitlements within the leprosarium. After entering, these men’s previous identity as Benedictine monks was not fully superseded by their newer identity as leprosy sufferers. Evidently not all the resident lepers at Mont-​aux-​Malades ate the same diet; the specific diet of individual sufferers often related more to their religious or social status than to ideas about dietary care. Nonetheless, it is notable that the monks of Saint-​Ouen, like the leprous women of Salle-​aux-​Puelles, were to consume mild and moist foodstuffs.

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In some instances leprosy sufferers occupied their own private accommodation within or adjacent to leprosaria, making it possible for them to eat and drink separately. A  document marking the entry of Jehan Duquesnoy, called ‘le Bourguignon’, ‘ladre’, to the leprosarium of Saint-​Lazare at Aumône near Pontoise (north-​west of Paris), issued on Tuesday 17 May 1412, confirms the arrangement for the leprosarium’s master, Jehan de Chamigny, to provide him with his own lodging, with ‘drink, food, fire, bed, accommodation and all his other necessities, lawfully according to his estate’.34 Duquesnoy had the right to enter the leprosarium for the rest of his life because he had been born within the town of Pontoise. The reference to his social rank or ‘estate’ suggests that he was of elevated status. The leprous man brought with him his own possessions, including a bed, linen sheets, table cloths and other items.35 While this man’s social status may have afforded him private accommodation, it is also possible that he was the only sick person resident at the hospital at this date, since at the end of the document provision is made for the allocation of resources if, in the future, several leprous individuals born in Pontoise are received there.36 One can assume that Duquesnoy’s accommodation permitted him to eat meals privately:  indeed, a ‘cooking pot’ is included among the possessions with which he entered the leprosarium.37 The availability of food and drink formed part of the wider undertaking of the hospital’s master to provide him with the necessities of life, including warmth and shelter. The details of the reciprocal obligations between both parties include the master’s undertaking to deliver quantities of wine and grain to Duquesnoy, which would have formed part of his diet. The document specifies that the wine should come ‘from Cergy-​lès-​Pontoise or from Nevers, which ever pleases the ladre better’, suggesting that this wine was intended to be of a quality that would provide enjoyment, perhaps supporting a higher status lifestyle.38 Statutes for the Pontoise leprosarium issued a century earlier, in July 1315, mention the cultivation of its landed estates and vineyards; however, the wine provided to the leprous man came from elsewhere, rather than being produced by the hospital.39 Duquesnoy was also permitted to leave his lodging to seek things, no doubt including foodstuffs, and purchase them; he could travel widely, as long as he did not enter Pontoise or the

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parish of Saint-​Ouen (at Aumône). This provision suggests that the specific arrangements for leprous persons born in Pontoise to enter the leprosarium entailed their prohibition from frequenting the streets of the town and the parish in which the hospital was located,40 but not from moving around the region. Within the supportive framework of a leprosarium, this leprous man therefore had considerable agency with respect to his diet, as well as other aspects of his lifestyle.

Almsgiving to leprosy sufferers Distinctions of identity and status also came into play at the boundary point between leprosaria and the world outside. The August 1249 statutes for Salle-​aux-​Puelles at Rouen instruct the prior of the community to conserve the remaining fragments of food ‘for poor leprosi from outside’.41 According to Archbishop Eudes Rigaud’s visitation records, on 11 February 1265 (= 1266) the community was indeed conserving the vestiges of its food for a leprous woman at Moulineaux, a nearby village of which the leprosarium held the patronage of the church.42 As well as reflecting the aristocratic status of the residents of Salle-​aux-​Puelles, this act fitted into patterns of monastic almsgiving in the region. In January 1254 (= 1255), for example, Eudes Rigaud observed that the Augustinian canons of Bourg-​Achard were donating the remainders of food from the refectory and from guests to leprosi.43 The act of giving away food to leprosy sufferers who were hungry demonstrates the range of identities of sufferers within a given locality. The leprous residents of Salle-​aux-​Puelles had too much food, whereas a local leprous woman was in the position of requiring their leftovers. This woman was evidently not of sufficiently high social status to be admitted herself to Salle-​aux-​ Puelles. Itinerant leprosy sufferers, who did not join leprosarium communities because they lacked the means or the right to be admitted, or because they chose not to do so, largely depended upon begging and distributions of alms for their sustenance.44 At a number of cities in medieval northern Europe, leprosy sufferers were permitted to enter at stipulated times, to receive distributions of food at cathedrals and other public locations. The best-​known example is that of Nuremberg, where a special charitable feast

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for people with leprosy for three days during Holy Week was established in 1394, and by the sixteenth century this had become an annual event that saw thousands of poor people designated as leprosi seeking alms, medical attention and other forms of support in the churchyard of Saint Sebaldus, one of the major city churches. As Fritz Dross has demonstrated, the public proffering of food to leprosi, including cod, vegetables, almonds and figs, was central to this festival. Holy Week was an appropriate time for the event, since Maundy Thursday commemorated the Last Supper of Christ and his disciples.45 It is likely that similar, albeit less elaborate, arrangements were in place at Rouen as early as the beginning of the fourteenth century. The testament of the Rouen resident Jean Hardi, issued in 1304, bequeathed money to support the groups of poor leprosi who flocked together at the cathedral on Good Friday and during Ascension.46 In the later Middle Ages, in the Pas-​de-​ Calais region, leprosy sufferers could enter the towns of Montreuil and Saint-​Omer three times per year; at the town of Aire, they could enter on Friday mornings.47 The residents of the less affluent leprosy hospitals were also among those who begged: the statutes of the leprosarium of Saint-​Lazare at Meaux (north-​east of Paris), drawn up almost certainly in Latin in the late twelfth century and surviving in a French translation in a fourteenth-​century cartulary, permit the residents to go out to beg alms, provided that they have the master’s prior permission.48 These arrangements reveal how the procurement of food, an essential necessity of life, was one of the reasons for the leprous temporarily to come into contact with wider society. Nonetheless, the non-​leprous agents of people with leprosy also played an essential role with regard to obtaining food. At Aire and Arras, representatives of leprosi (often spouses or other relatives, or servants) were permitted to beg in their place.49 At the leprosarium of Saint-​Lazare at Falaise (Lower Normandy), servants fetched bread for the sick, and brought them water before they had a well in the later fifteenth century.50

Diet, order and punishment within the leprosarium As well as varying according to identity and status, access to food and drink within leprosaria was sometimes controlled in order to ensure that residents lived devoutly and chastely. The ordinance

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for the leprosarium at Meaux, which provided for male and female leprosy sufferers, instructs that silence should be observed at the (dining) table, as also in the church, indicating that here communal meals were not intended to be a moment of social interaction. Furthermore, as was stipulated in the statutes of other mixed leprosaria, the male and female residents, healthy and sick, were to eat separately. Punishments for fornication and other offences were based upon food and drink. For example, a leprous man found in the areas occupied by the women, whose reason for being there was not backed up by a reliable witness, would be required to abstain from drinking wine and eating meat for three days. If he was found at night with a woman, he would be put on a diet of bread and water.51 The fact that dietary embargoes were used as a punishment mechanism, as also occurred at the female leprosarium of Saint Leonhard in fourteenth-​ century Nuremberg, suggests that food and drink were among the few pleasures of life within leprosaria.52 Other elements of the dietary allowance of the sick at Meaux included bread, salt, flour and white cheese. In accordance with the life of a religious community, the leprous were permitted to have special allotments of meat at certain times in the calendar: one portion of lamb each at Ascension and Pentecost, and a portion of pork on the feast of All Saints and at Christmas.53 One of the offences for which the residents of the leprosarium of Meaux could be punished itself involved food: anyone who threw food or drink ‘through indignation or through anger’, or gave it away outside the community, would be deprived of that food for the space of a week.54 This tenet underlines the fact that food and drink were precious resources within the community that were not to be wasted or given up lightly. It also indicates that meal times, supposed to be silent, may have occasionally witnessed outbursts of frustration, and indeed resistance, by the residents who were compelled to follow the house’s rules.55

Contamination and contagion Although, as we have seen, until the fourteenth century leprosy was primarily understood to be caused by humoral changes within the body, rather than by factors outside it, there was evidently

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concern regarding the transmission of leprosy from person to person from at least the thirteenth century. Rules drawn up for the Rouen leprosarium of Mont-​aux-​Malades by Peter de Collemezzo, archbishop of Rouen (1236–​44), in May 1237 state: ‘If it should happen that the parents or relatives of the leprosi or others … are permitted to sit or drink with the leprosi, we will consider them to be infected.’56 The archbishop’s statement suggests that he believed that the leprous could contaminate others through close contact with them, especially at moments when food and drink were shared. The verb inficere (‘to infect’) was used in relation to leprosy in other contexts in the t​ hirteenth century, but although it appears to reflect the word’s modern-​day sense, it may not have had exactly the same meaning at this time as it does today. Archbishop de Collemezzo may have understood that those who came into physical proximity or contact with the leprous would be tainted or contaminated in some way (physical or moral), but not necessarily that they would literally contract the disease.57 The statutes of the leprosarium at Amiens in the far north of France, confirmed in 1305, also indicate concerns about contact between the leprous and the non-​leprous with respect to food and drink. The leprous brothers were forbidden from entering areas that were regularly used by the non-​leprous brothers, including the kitchen, the cellar and ‘the grange where wheat and oats are threshed’.58 This provision noticeably relates to areas of the hospital where food and drink were stored and prepared, and could suggest that leprosy sufferers were believed to contaminate the produce consumed by the non-​leprous if they came into contact with it. Nonetheless, the provisions at Amiens may also reflect the view that members of each constituent group in the community should occupy their own distinctive space, according to their identity and status: thus, the leprous were not to intrude upon the areas of the hospital reserved for the use of the non-​leprous. While leprosi may have been understood to contaminate food and drink, in certain instances they themselves were perceived as the appropriate recipients of contaminated food that was considered unfit for public consumption. Since they were already diseased, it was held that this food posed no risk to their health. Contaminated food was certainly distributed to leprosy sufferers in England, although evidence for the practice in northern France

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is less forthcoming. Saint Giles’s leprosarium at Maldon (Essex) received ale, bread, meat and fish that was forfeited within the town, and the butchers of York surrendered rotten meat to the leprous.59 In 1224, having besieged Bedford Castle, King Henry III ordered the local sheriff to donate the ‘rotten and old’ bacon from the castle store in alms to leprosy sufferers and paupers; the bacon that was still considered good was held back for the king’s use until he ordered otherwise.60 Contaminated food was perceived as a key cause of the spread of disease, including leprosy. Pork that was marked with spots and swellings was one of the most common forms of substandard food. Such meat was visually reminiscent of the symptoms of leprosy, heightening the perceived link between the disease and contaminated food.61 Indeed, there were especial anxieties regarding leprosy and meat. The statutes regulating the activities of butchers in Rouen issued in June 1432 forbade the butchers from selling the flesh of any beast that came from a leprosarium, indicating a suspicion that animals reared on the landed estates or within the grounds of leprosy hospitals contracted the disease; it would then be transmitted to any humans who consumed their meat.62 Butchers were themselves sometimes identified as leprosy sufferers, such as Tassart Egle, butcher and burgess of Saint-​Omer, who entered the town’s leprosarium of La Madeleine on 4 December 1426.63 Substandard food was not only distributed to people with leprosy and paupers: the 1432 statutes regulating butchery at Rouen stated that such food was sometimes supplied to prisoners.64 By the later Middle Ages, as anxieties about public health and hygiene increased in the context of recurrent plague outbreaks, groups associated with the spread of illness, including leprosy sufferers and the vagrant poor, were viewed less positively. The consignment of substandard food to the leprous, and the idea that they themselves could contaminate dietary produce, reflect the ambivalent responses they elicited in contexts where the health of society more broadly was under threat.

Conclusion While dietary provision in some of the larger leprosy hospitals of medieval northern France was partially in tune with theoretical

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medical thinking about diet and leprosy, much of the evidence regarding food and drink within these institutions points towards an emphasis on basic sustenance and hospitality, rather than towards a therapeutic dietary regimen. At another kind of medieval hospital, that for the sick poor, dietary arrangements were similarly distinct from the provision of medical care. The records of the Hôtel-​Dieu of Paris from the later Middle Ages reveal that, while the very ill were afforded more choice over what they ate and how it was prepared, food and drink were considered separately from medical treatments such as bloodletting and the application of plasters.65 The supply of food and drink to leprosaria, represented in grants of alms such as Henry II’s gifts of herring to Mont-​aux-​Malades at Rouen, helped these communities to remain integrated with wider society, since charitable donors remembered and supported them with gifts in kind. Yet within the leprosarium, despite an emphasis on communal meals, food and drink served as key markers of identity and status, distinguishing the leprous from the non-​leprous religious and staff, and different leprosi from each other. Different dietary allowances, and the prohibition of the leprous from coming into contact with the food and drink of other residents, created lines of separation within the community. In northern France, as in England and other parts of medieval Europe, the leprous had a range of identities and experienced a range of responses to their sickness. In the institutional setting of the leprosarium, eating and drinking had great religious and social significance; information about this aspect of community life sheds light on the experiences of leprosy sufferers themselves, as well as on perceptions of them and their disease.

Notes 1 On food in the Middle Ages, see, for example, C. M. Woolgar, The Culture of Food in England, 1200–​1500 (New Haven: Yale University Press, 2016). 2 On leprosy and malnutrition in modern-​day India, see discussion below. 3 On the monastic character of leprosaria, see E. Brenner, ‘The medical role of monasteries in the Latin West, c. 1050–​c. 1300’, in A. Beach and I. Cochelin (eds), The Cambridge History of Medieval Monasticism in

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the Latin West, Vols I and II (Cambridge: Cambridge University Press, 2020), pp. 865–​81. 4 P. Scholliers, ‘Meals, food narratives, and sentiments of belonging in past and present’, in P. Scholliers (ed.), Food, Drink and Identity: Cooking, Eating and Drinking in Europe since the Middle Ages (Oxford: Berg, 2001), pp. 3–​10. 5 See C. Roberts, Chapter 1 in this volume. 6 C. Niel and M.-​C. Truc (with B. Penna), ‘La chapelle Saint-​Thomas d’Aizier (Eure): Premiers résultats de six années de fouille programmée’, in B. Tabuteau (ed.), Etude des lépreux et des léproseries au Moyen Age dans le nord de la France:  Histoire  –​archéologie  –​ patrimoine (Amiens: CAHMER, 2007), pp. 97–​100. 7 On advice literature, see, for example, C.  A. Bonfield, ‘The Regimen sanitatis and its dissemination in England, c. 1348–​1550’, Ph.D. dissertation (University of East Anglia, 2006). 8 Demaitre, Leprosy, pp. 164–​5. 9 The Surgery of Henri de Mondeville, Surgeon of Philip the Fair, King of France, trans. and ed. L. D. Rosenman, 2 vols, Vol. II ([Philadelphia, PA]: XLibris, 2004), pp. 783–​4. 10 E. Brenner, ‘Leprosy and public health in late medieval Rouen’, in L. Clark and C. Rawcliffe (eds), The Fifteenth Century XII:  Society in an Age of Plague (Woodbridge:  Boydell Press, 2013), pp. 128–​9; Demaitre, Leprosy, pp. 165–​6. 11 Mondeville, The Surgery, Vol. II, p. 785. 12 C. Rawcliffe, Urban Bodies: Communal Health in Late Medieval English Towns and Cities (Woodbridge: Boydell Press, 2013), pp. 237–​8. 13 P. S. S. Rao and A. S. John, ‘Nutritional status of leprosy patients in India’, Indian Journal of Leprosy, 84 (2012), 17–​22. 14 Mondeville, The Surgery, Vol. II, pp. 783–​4, 785. 15 Rawcliffe, Leprosy, p. 213. 16 D. Hillard, Traité des eaux artificielles; ou, Vertus des eaux et des herbes: Le texte, ses sources et ses éditions (Geneva: Droz, 2012), pp. 9, 400, 408, 417, 420, 421. 17 Le traicte des eaues artificielles, les vertus et proprietez dicelles ([Rouen?]: [n.p.], [n.d.]), sig. A2; Hillard, Traité, p. 400. 18 London, Wellcome Collection, EPB/​A/​7415. 19 Paris, BnF, MS latin 1245. The manuscript is edited (Regestrum visitationum archiepiscopi Rothomagensis: Journal des visites pastorales d’Eude Rigaud, archevêque de Rouen. MCCXLVIII–​MCCLXIX, ed. T. Bonnin (Rouen: Le Brument, 1852)), and translated (The Register of Eudes of Rouen, trans. S. M. Brown, ed. J. F. O’Sullivan (New York: Columbia University Press, 1964)).

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20 On Salle-​aux-​Puelles, see E. Brenner and B. Tabuteau, ‘La Salle-​aux-​ Puelles, à Rouen:  Une léproserie de femmes’, Revue de la Société 50; E.  Brenner, française d’histoire des hôpitaux, 152 (2014), 44–​ Leprosy and Charity in Medieval Rouen (Woodbridge: Boydell Press, 2015), pp. 58–​77. 21 See the discussion of gender and the life cycle in the Introduction to this volume, p. 8. The statutes for Salle-​aux-​Puelles inform us, for example, that the female residents were to be served by a female bloodletter: Brenner, Leprosy and Charity, p. 93. 22 Bonnin, Regestrum, p. 101; Brown and O’Sullivan, Register, p. 116. 23 Ale was the customary drink at English leprosaria: Rawcliffe, Leprosy, pp. 326–​7. 24 Bonnin, Regestrum, p. 101; Brown and O’Sullivan, Register, p. 116. Similarly, at a major hospital for the sick poor, the Hôtel-​Dieu of Paris, the same diet was shared by the sick and the hospital staff in the later Middle Ages. C. Jéhanno, ‘L’alimentation hospitalière à la fin du Moyen Age: L’exemple de l’Hôtel-​Dieu de Paris’, in G. Drossbach (ed.), Hospitäler in Mittelalter und Früher Neuzeit: Frankreich, Deutschland und Italien. Eine vergleichende Geschichte (Munich: R. Oldenbourg, 2007), p. 124. 25 Bonnin, Regestrum, p. 101; Brown and O’Sullivan, Register, p. 116. 26 Woolgar, Culture of Food, p. 169. 27 Although the historical year here is 1260, the date is listed as 5 March 1259 in Archbishop Rigaud’s Register because at this time the ecclesiastical year began on 25 March, the Feast of the Annunciation. 28 ‘non habebant bladum ad vescendum, nec avenam ad serendum’. Bonnin, Regestrum, p. 361; Brown and O’Sullivan, Register, p. 410. 29 Bonnin, Regestrum, p. 499; Brown and O’Sullivan, Register, p. 569. 30 E. Brenner, ‘Charity in Rouen in the twelfth and thirteenth centuries (with special reference to Mont-​ aux-​ Malades)’, Ph.D.  dissertation (University of Cambridge, 2007), pp.  139–​41; Brenner, Leprosy and Charity, pp. 153 (no. 30(e)), 154 (no. 30(g)). 31 Herring also featured in thirteenth-​century grants of alms to leprosaria by King Henry III of England and King Louis IX of France: K. Phillips, ‘The leper and the king: The patronage and perception of lepers and leprosy by King Henry III of England and King Louis IX of France’, Ph.D. dissertation (University of Reading, 2018), pp. 183, 202–​3. 32 Brenner, Leprosy and Charity, p. 155 (no. 32). 33 Ibid., p. 172 (no. 86). 34 ‘boire mengier feu lit hostel et toutes | ses autres neccessitez licetement selon son estat’. London, Wellcome Collection, MS 5133/​1. 35 Ibid.

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36 Ibid. 37 ‘un pot de cuisine’. Ibid. 38 ‘un mine [?]‌de vin prins a cergy lez pontoise ou a nivers lequelque mieulx plaira audit ladre’. Ibid. At the Hôtel-​ Dieu of Paris, the gravely ill were permitted to consume better-​quality wine. Jéhanno, ‘L’alimentation hospitalière’, p. 123. 39 ‘Statuts de la léproserie de Pontoise’, in Statuts d’Hôtels-​Dieu et de léproseries: Recueil de textes du XIIe au XIVe siècle, ed. L. Le Grand (Paris: Picard, 1901), p. 233. 40 ‘domus Sancti Lazari de Pontisara … in parrochia de Sancto Audoeno … juxta locum qui dicitus Elemosina sita’. Ibid., p. 231. 41 ‘pauperibus leprosis extraneis’. Bonnin, Regestrum, p. 101; Brown and O’Sullivan, Register, p. 116. 42 Bonnin, Regestrum, p. 538; Brown and O’Sullivan, Register, p. 615. 43 Brown and O’Sullivan, Register, p. 218; Bonnin, Regestrum, p. 201. On monastic distributions of food as alms, see Woolgar, Culture of Food, pp. 224–​8. 44 On itinerant leprosy sufferers, see Part III of this volume. 45 F. Dross, ‘ “Man does not live by bread alone”: Feeding confraternity in early modern Nuremberg leprosaria’, Food & History, 14 (2016), 35–​53 (pp. 40–​2). 46 Brenner, Leprosy and Charity, pp.  80, 158 (no.  43). The situation was similar in Siena, where leprosi could stay in the city during Holy Week: see A. M. Peterson, Chapter 11 in this volume, p. 333. 47 A. Bourgeois, Lépreux et maladreries du Pas-​de-​Calais (Xe–​XVIIIe siècles) (Arras:  [Commission départementale des monuments historiques du Pas-​de-​Calais], 1972), p. 66. 48 ‘Statuts de la léproserie de Meaux’, in Le Grand, Statuts d’Hôtels-​Dieu et de léproseries, pp. 184–​90 (p. 185). 49 Bourgeois, Lépreux, p. 66. 50 D. Jeanne, ‘Le groupe des lépreux à Saint-​Lazare de Falaise aux XIVe et XVe siècles’, in B. Tabuteau (ed.), Lépreux et sociabilité du Moyen Age aux Temps modernes (Rouen:  Publications de l’université de Rouen, 2000), pp. 39–​61 (p. 53). 51 ‘Statuts de la léproserie de Meaux’, p. 185. 52 See Dross, ‘Man does not live by bread alone’, pp. 44–​5. 53 ‘Statuts de la léproserie de Meaux’, pp. 185–​8. 54 ‘par indignacion ou par couroulz’. Ibid., p. 185. 55 On resistance and contestation in relation to leprosy in Dutch colonial Suriname, see S. Snelders, Leprosy and Colonialism: Suriname under Dutch Rule, 1750–​1950 (Manchester:  Manchester University Press, 2017), p. 9.

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56 ‘si vero contigerit quod aliqui parentes uel consanguinei leprosorum vel alii … permittantur consedere vel bibere cum leprosis, nos ipsos contingamus Infici’. Paris, Archives nationales, S4889B, dossier 13, doc. (xxi), fo. 2r; see Brenner, Leprosy and Charity, pp. 99–​100. 57 On ambivalent responses to leprosi in the twelfth and thirteenth centuries, linking them not only to purity and sanctity, but also to immorality and sinfulness, see D. Jeanne, Chapter 3 in this volume. 58 ‘le grange là où on bat le blé et l’avaine’. ‘Statuts de la léproserie d’Amiens’, in Le Grand, Statuts d’Hôtels-​ Dieu et de léproseries, pp. 224–​30 (p. 226). 59 Rawcliffe, Leprosy, p. 79; Rawcliffe, Urban Bodies, pp. 236–​7. 60 Phillips, ‘The leper and the king’, pp. 183, 257. I am very grateful to Katie Phillips for alerting me to this reference, and for sharing her unpublished Ph.D. thesis with me. 61 Rawcliffe, Leprosy, p. 80; Rawcliffe, Urban Bodies, p. 234. 62 Brenner, ‘Leprosy and public health’, p. 129. 63 Bourgeois, Lépreux, p. 315. 64 Brenner, ‘Leprosy and public health’, pp. 128–​9, 130. 65 Jéhanno, ‘L’alimentation hospitalière’, pp. 123–​6.

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Part III

Beyond the leprosy hospital: the language of poverty and charity

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7 Good people, poor sick: the social identities of lepers in the late medieval Rhineland Lucy Barnhouse As François-​Olivier Touati has observed, views of the leper as Other within medieval societies are closely bound up with the Othering of medieval society itself.1 It is the aim of this chapter, which focuses on leprosy in the late medieval Rhineland, to help illuminate the diverse social realities of those viewed as ‘lepers’ in medieval Europe. Leprosy, I argue, did not erase previous social identities, as has sometimes been claimed.2 Rather, medieval ‘lepers’ derived their identity from where they lived, and from the communities of which they were part.3 The vocabulary used for those designated as leprous in the late medieval Rhineland (western Germany) reveals not only a variety of responses to them, but a variety of ways in which they could choose to live. I follow the terminology both of canon law and of legal agreements in using leprosarium as a recognised term for a type of hospital, parallel to xenodochium, elemosynarium and hospitalium in possessing the privileges and obligations of religious status, and conferring that status on the hospital’s residents.4 In addition to examining such institutions, I  look at informal communities of lepers, often located near crossroads. The latter, because of the paucity of sources, have not yet been the subject of analysis.5 An examination of the vocabulary applied to such communities, however, has allowed me to draw some conclusions about how they lived and were perceived. The sources on which I  base my study, not hitherto the subject of close analysis, reveal both the individual and collective agency of medieval lepers, as well as a range of social responses to them. They also demonstrate that medical diagnosis and what I  call social diagnosis  –​the response of medieval communities to lepers or putative lepers  –​were not

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consistently correlated. Drawing on multiple source types allows me to see more clearly where the rhetoric or priorities of a genre of writing may distort our picture of medieval lepers and leprosy.

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Terminology Special attention is warranted by the terms ‘leprosy’ and ‘leper’.6 As has been widely observed, it would be misleading to treat Hansen’s disease and medieval lepra as identical; I  argue that it is also inappropriate to assume continuity between ancient and medieval attitudes towards conditions identified as ‘leprosy’.7 Medieval vocabulary for the disease and those deemed to be afflicted with it was remarkably labile.8 Lepra and elephantiasis were both used as specific terms for leprosy; sometimes, however, it is only context that tells us that infirmi were thought to be affected by this disease.9 The Latin adjective misellus/​a (‘poor’, ‘wretched’) entered European vernaculars as mesel/​meselle, and in Middle High German the sick could be Aussätzige (lepers), but were often simply die armen Siechen (the sick poor) or, still more ambiguously, die armen Kinder Gottes (the poor children of God).10 In the central Rhineland, the latter term was frequently used for informal communities established at crossroads, while in the lower Rhineland, around Trier, it could also be applied to those residing in leprosaria.11 Throughout this chapter, I  use ‘leper(s)’ to refer to those known under this range of terms, known as residing in leprosaria, or appearing in the sources as potentially having Aussatz (leprosy). Where possible, in referring to groups, I follow Elma Brenner’s use of ‘the leprous’.12 It is difficult, however, to find another single term for the individuals whose diverse lives and multifaceted identities are here under discussion.13 In using the term ‘leper(s)’, I  aim, moreover, to demonstrate the ways in which people thus known exercised individual and collective agency. As Anna M. Peterson observes, while ‘leper’ became and remains a pejorative label in the modern world, it was a multivalent term in the medieval period.14 As I shall argue, having a disease known as leprosy was only one of the factors affecting the identities of the men and women who were, to their Rhineland neighbours, the poor children of God.

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Sources In attempting to reconstruct the ways of life available to the leprous in the late medieval Rhineland, I have chiefly used charters preserved in the archives of Mainz and Darmstadt. I have also used the internal records of hospitals: the cartularies and account books of the leprosaria of Mainz, Worms and Speyer document how their residents, both healthy and sick, participated in the socio-​economic networks of late medieval cities. A  comparison of the statutes of leprosaria with those of multipurpose hospitals in the cities of Mainz, Worms and Speyer indicates that such regulations were primarily affected by hospitals’ legal status as religious institutions, rather than by attitudes towards the leprous and other sick.15 Particularly in order to find references to informal communities of lepers, I have drawn on the account books of monastic houses. Lastly, I  have examined the fifteenth-​century letters of diagnosis created by the physicians of Frankfurt responsible for the examination for leprosy, the Lepraschau. The experiences of those seeking, or subjected to, a medical verdict often show that their social relationships affected how, and why, they came before Frankfurt’s Lepraschau committee. The nature and effects of a diagnosis of leprosy in the Middle Ages have been much debated.16 This disease, so easily recognisable in the stylised form given to it by the authors of romances, sermons and saints’ lives, often defied precise classification by those charged with medical diagnosis.17 Many scholars have claimed that fear of ambiguity drove medieval communities to ensure that the leprous would be set apart by distinctive clothing, and by membership  –​ constrained if necessary  –​in leprosaria.18 The evidence from the archdiocese of Mainz does not bear out such claims. When leprosaria were the objects of regulation, it was as religious institutions, rather than as sites of medical control.19 The rule of Speyer is concerned with the institution’s internal regulation; later privileges, similarly, prioritise the rights of the hospital and its residents as religious persons.20 Moreover, a papal privilege of the fourteenth century treats the hospital as belonging to its residents, rather than designed for their social or spiritual discipline.21 The twelfth-​and thirteenth-​century rules for French leprosaria edited by Léon Le Grand provide rich evidence for ongoing social ties.

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Numerous regulations are designed to regulate the interactions of residents with people outside hospitals. The 1315 statutes of Pontoise, for instance, declare that family members of the leprous cannot be taken under the legal authority of the house unless they make vows and take the habit:  an interesting indication of how difficult it might be to establish firm boundaries between the community inside the hospital walls and that outside them.22

Rules for leprosaria The first extant rules for the leprosaria of the Rhineland post-​ date the first recorded existence of such institutions by more than three centuries. A  domus leprosorum appears in association with a church in 1109, but the earliest extant rule for a leprosarium is that of Worms, from 1440. The data from the Rhineland show a different pattern from that of French and English evidence in the use and understanding of leprosaria in the fourteenth and fifteenth centuries.23 Rather than declining in numbers and prosperity, these Rhineland leper hospitals continued to receive donations and actively to manage their property as religious institutions well into the early modern period.24 Their long history without external regulation suggests that, in this region, the distinctive purpose of leprosaria gave them a security in religious status that multipurpose hospitals did not enjoy. The leprosarium of Worms was a focal point of a neighbourhood despite being on the outskirts of the city; moreover, its inhabitants were enmeshed in the city’s property markets.25 The rule of Worms echoes religious language, and shares priorities common to numerous hospital rules from the preceding centuries. Its central and primary concern is obedience: Whereas the lepers [armen ußgesetzten siechen] who hitherto have lived in our city’s residence [hof] on the street leading towards Speyer, both men and women, who have been received both from our city and the surrounding countryside for the love of God, have shown great disobedience to us, to the masters of our council, and to the administrators of the house. Moreover, they have within the house had great discord and dishonourable relationships with each other. On the streets, in the countryside and in our city they have

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not behaved or comported themselves as poor sick lepers [ußgesetzte arme siechen].26

Although the hospital’s residents are referred to as lepers, ‘armen siechen ausgesetzt’, there are no indications that they were shunned by the healthy population of Worms. Rather, their presence in the city is expected: they are directed to wear their grey felt hats if they sit on the street or go into the city, to the churches or elsewhere. This suggests that the sick themselves had some autonomy in deciding when and how to interact with the outside world. It is anticipated that the lepers of Worms will go shopping, but should not touch things in the market, rather indicating them with their clappers.27 Moreover, the rule portrays the lepers’ distinctive clothing as a form of identification –​fulfilling the requirement for religious persons to wear a habit  –​rather than as an inalienable marker of disease.28 Leper hospital rules reveal parallels to those of multipurpose institutions, as well as ways in which lepers could live in society in a state of semi-​integration, to use Guy Geltner’s term.29 Mainz’s Heilig Geist Spital, a multipurpose hospital run by a mixed-​gender staff until 1259, received its first statutes in 1236. In this institution, care for lepers appears to have been offered alongside that for the other sick poor, possibly in an adjoining facility. Its statutes, explicitly offering a universal welcome, are not the only indication of such a practice. The hospital properties surrounding its main building on the banks of the Rhine included a small house frequently referred to in extant account books, sometimes by name as the ‘Roten Kopf’. This, and the iconography of the ‘ruddy head’ on the sign, recorded in the early modern period and to this day, suggest an association with lepromatous leprosy. That the hospital continued to care for lepers (at least as occasion offered) into the late fourteenth century is indicated by a will of 1379 giving a gift to the ‘maleden siechen’.30 Surprising though it is to find the leprous cared for here as well as in the city’s leprosarium of Saint Georg, identification of the hospital is unambiguous, and the word ‘maleden’ is consistently and exclusively used to denote those identified as having leprosy.31 Care at the Heilig Geist Spital may have served as an alternative for those not admitted by Saint Georg. Saint Georg itself managed two locations: one in the semi-​rural belt along the Ambach river, and one on the main road about a

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mile outside the city walls.32 The hospital held exclusive power over admission until the late fifteenth century. The archbishop’s assignment of inspection for admittance to Saint Georg to members of the university’s medical faculty at this time might at first glance appear to be a straightforward case of medicalisation. However, the political context of the decision, and its eventual recantation, suggest other forces at work. The archiepiscopal abridgement of the hospital’s autonomy occurred shortly after Archbishop Berthold’s reconquest of the city, in the wake of which he also reclaimed control of the Heilig Geist Spital from the city’s council.33 When, some twenty years later, the lepers of Saint Georg claimed the right of examination for admission as their ancient prerogative, it was granted with the proviso that a civic official would be on the examining committee, and would be paid for his efforts. Medical professionals were to be paid for consultation in difficult cases. The terms of the agreement suggest tensions over jurisdiction –​and over fees! –​rather than over medical expertise or civic policy regarding lepers.34 It is this agreement, made in 1488, that is the closest thing Saint Georg has to a rule for the medieval period. The lepers of Saint Georg appear to have valued their collective authority; their court records show that their staff and servants often had multigenerational relationships with the close-​ knit community. Much historiography has considered medieval hospitals –​ particularly leprosaria –​as institutions primarily acted upon by ecclesiastical and civic officials, but the records of Saint Georg tell a different story.35 Its cartulary, which preserves records of legal process in unusual detail, suggests that ongoing relationships between lepers and non-​ lepers were normative, not exceptional interactions taking place despite an exclusionary culture of fear.36 As religious persons, lepers  –​like monks and nuns  –​could not themselves appear in court. Saint Georg’s cartulary, however, does not show them as ciphers or as mere objects of charity. Ongoing social ties between hospital residents and the wider community are indicated by gifts. One such donation is made in honour of a certain Henne von Eberscheim, who took up residence in the hospital after a period of living outside it, perhaps in an informal community; he is described as ‘etzwanne feltsieche’.37

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Informal leper communities Less closely regulated  –​but, by the same token, less fully recorded –​are the relationships between informal communities of the leprous and their donors and neighbours.38 In the absence of written records created by or for such communities  –​at least in the central Rhineland –​it is impossible to reconstruct their internal organisation, much less their social composition. However, an examination of the vocabulary applied to such communities (and, where relevant, of any detail used in describing them) has allowed me to draw some tentative conclusions. While the membership of such communities may have been fluid, the assemblies themselves were acknowledged as at least semi-​permanent. This is indicated by the presence of consistent geographical markers in charters from multiple institutions spanning several decades. A group near Mainz known as the ‘Walpoden kinder’ appears in records across the fourteenth century; it is perhaps significant that all the institutions mentioning the group were themselves associated in some capacity with the care of the sick.39 No extant civic records, from Mainz or elsewhere, suggest that the Walpode, a local official charged with keeping order, was associated ex officio with the care (or discipline) of the sick, but this may have been a local tradition. Groups might be designated only by the name of the person in charge of them, which can make them difficult to identify; the lepers led by Richiwin and the lepers led by Reysemann may or may not be the same community, identified by the name of their master. One group is known as the ‘Kocheimer’ or ‘Kochener’ kinden.40 The association with a cook or cooking pot may seem an incongruous one, but the prohibition, from Worms, on lepers using the ordinary public ovens suggests the possibility that such facilities for the use specifically of the leprous would have been a desideratum.41 The most prominent of such informal leper communities was that at Heilig Kreuz, a crossroads just across the Rhine from Mainz. This community is sometimes referred to as the ‘guden leuden’ or ‘maledern’.42 It was also the most prosperous of its type, to judge by the mentions of acres of land belonging to it.43 Heilig Kreuz may have gained some of its properties from its residents. In a donation charter of 1458, a husband and wife ‘living at the Heilig Kreuz by

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Mainz’ give numerous acres to a Benedictine monastery, suggesting that they may have had other land to bestow, or at least that some of Heilig Kreuz’s residents were reasonably prosperous.44 Not only do the charter’s property descriptions evoke an extra-​mural landscape richly populated with charitable institutions, they also convey a sense of the landscape as it was experienced and used.45 Fulher and Kette’s donations begin ‘by den guden leuden’ and proceed outwards from the leper community, often using hospitals as landmarks:  Saint Georg; the Heilig Geist Spital; and unnamed ‘gastmeisterien’, houses for pilgrims and travellers.46 The question of vocabulary brings us to another point regarding these informal communities. In contrast with the leprous residing in hospitals in this region, who are most often referred to as ‘guden leuden’, good people, leprous in more transient communities are almost always described as ‘armen kinden’, poor children; the implication is that they are the poor children of God. Such a designation for leprous was more common in the lower Rhineland:  the leprosarium of Münster, for instance, was called the Kindenhaus. Maledern, a version of the term for lepers that gave the great leprosaria of Köln and Aachen their names, appears only infrequently.47 At least in this region, the two more common terms for lepers appear to have held differing connotations. Lepers in hospitals, enjoying the legal privileges and observing the disciplines of religious persons, could be referred to as ‘good people’ and, as such, were often the recipients of donations.48 Outside such communities, the ‘poor children of God’ were more reliant on occasional alms. It need not be inferred, however, that they were viewed as undesirable outcasts; informal communities were acknowledged as permanent fixtures of the landscape  –​ clearly capable of sustaining themselves  –​and sometimes even as landowners. The extant records do not show the kind of sharp distinction between leprosaria and informal communities that Peterson has found for Siena and Narbonne.49 In some cases, it can even be difficult to distinguish between these groups and the more privileged leprosaria, as in a canonry’s cartulary that describes a property as bordering ‘den guden leuden’ or ‘den guden leuden zu Menctz’. The same codex contains explicit references to Saint Georg, but it is impossible to determine accurately the geographical location of these particular ‘good people’.50 Both the internal

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records of hospitals, and letters of medical diagnosis, suggest that those identified as lepers might exercise some autonomy in seeking membership in either of the types of community described above.51

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Leprosy examinations The fifteenth-​ century letters issued by the Frankfurt physicians charged with examinations for leprosy reveal a standardised medical procedure, and a wide variety of communal responses to the disease.52 I have chosen to analyse the latter as a social diagnosis, a process that existed parallel to –​and sometimes in tension with –​ the medical diagnosis carried out by the physicians. As Annemarie Kinzelbach has argued, civic leprosy inspections from the later Middle Ages onwards formed part of public health policies in the wake of the Black Death.53 Rather than a medicalisation of leprosy or of those who were diagnosed with it, or a so-​called professionalisation of medical care, what the records from Frankfurt and other cities show are the ways in which leprosy was imagined and dealt with as a contagion risk.54 As I  shall argue, moreover, they show a variety of ways in which those deemed to be leprous could be socially and spiritually integrated in their communities. Those who availed themselves of the committee’s inspection, or Lepraschau, hailed from a radius of over 100 km. Most of the surviving records are petitions, meaning that the outcome of diagnosis is almost always unknown. Three letters from the committee to their petitioners do survive, however, alongside one form-​ letter for such responses, and one standard to-​ do list, to which I will return shortly, for individuals diagnosed with leprosy. Two petition letters were sent to the committee by secular lords, and one by a religious community. Of the rest, a dozen come from private individuals, and eleven from civic authorities.55 Since half a dozen of the private letters came from one disgruntled individual, however, the majority of individual processes came to Frankfurt’s committee from civic officials.56 The first extant record for Frankfurt’s Lepraschau consists, anomalously, of two connected letters:  that written by the legal officers of Nierstein, and the committee’s response. While the letter from Nierstein is neatly written out with little abbreviation, that

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from Frankfurt is heavily abbreviated, with several interlinear corrections. This is suggestive of the committee adding specifics to a copied-​out form-​letter. The letter from Nierstein, like other civic-​ issued letters, emphasises the seriousness of the undertaking, and the respect with which the physicians are regarded. Several such letters specify that those coming to be inspected have been suspected of having leprosy for a long time, or by many; some explicitly request instructions on what steps should be taken if the person in question is indeed leprous. A letter sent by Frankfurt’s own council to the physicians asks if the person in question should be ‘ausgesetzt’, set apart from cities generally, or just from Frankfurt. This distinction is further nuanced by the surviving to-​do list for persons diagnosed with leprosy. The list defines the process of being ‘sonderlich ausgesetzt’, specially set apart from all people, as ‘not going to public kitchens or bathhouses’, a definition strikingly at odds with the apparently categorical language of diagnosis.57 Private individuals might also seek diagnosis, as a consequence either of observed symptoms or of communal concern. The process of diagnosis could be partially determined by individual agency, as well as by the committee’s recommendations. After many examinations of a certain Rupert Snyder  –​who may have been hoping for a better diagnosis after probation or an improved regimen –​the final verdict of the Frankfurt physicians is summed up in a single marginal note: ‘there is no comfort [for him]’.58 The case of a supplicant named Heinrich Wixhuser illustrates that the concerns of those petitioning the committee might not be primarily medical. Heinrich, a man prosperous enough to have his own seal, wrote to Frankfurt’s physicians saying that he was ‘willing to suffer any sickness if it be the will of God’, but that he believed the suspicion of leprosy (‘maledie’) arose from the ill will of his brother-​in-​law.59 Significantly, Heinrich also specifies that he is willing to make over his possessions as required by law, should he be diagnosed with leprosy. This is suggestive of the fact that, for prosperous citizens, ‘leprosy’ might be used as leverage on coveted property.60 Heinrich demands examination in remarkably specific terms:  ‘that you will examine and test, completely and in detail, among the rich and powerful and among the poor, of whatever origin or city they are. Examine me with the same standard that

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you use for the rich and powerful and for the poor –​in the same way for all  –​in order that this slander is not used to shame me and my friends.’61 For Heinrich, the social diagnosis of leprosy appears to have been damaging not only for him but also for those in his immediate circle. The consequences of a medical diagnosis, in contrast, he did not fear. Although Heinrich treats the physicians’ judgement as authoritative, their decisions were not always accorded respect. Indeed, community responses to an individual’s diagnosis were dependent on many social variables.62 The case of Henne Madern, which resulted in the creation of no fewer than six extant letters, illustrates some of the possible complexities involved.63 When Henne first appealed to the committee, on 29 September 1457, he had already undergone several medical examinations, and extended negotiation of his social status as a putative leper. In the first letter, Henne writes to the council in complimentary formulae. He does so having been ‘suspected [bedacht] of leprosy’ by Heinrich, civic doctor in Henne’s town of Ursel; a barber, presumably sought out for a second opinion; ‘and also others’. Evidence from later in the process suggests that this suspicion of leprosy was not merely –​or even primarily –​a medical one. Following inconclusive investigations, Henne went up to Cologne, to be inspected ‘by the accustomed people there’, with better results. ‘Almighty God’, writes Henne, ‘has shown me such grace that I was found free of leprosy, and I have a letter proving as much’. He appealed to the physicians of Frankfurt for confirmation of this satisfactory verdict; but in vain.64 Henne protested that the physicians of Frankfurt had accused (‘geschuldigt’) him of having leprosy. The Frankfurt doctors responded that they had found ‘that he had at that time begun to exhibit signs of leprosy, and was to a considerable degree spotted with it, as we have said according to our best belief and understanding’.65 In October, Henne wrote a letter acknowledging that he was marked with leprosy; this acquiescence would prove to be short-​lived.66 In the last of his letters, in 1458, Henne demanded the restoration of costs and damages, ‘as perhaps your committee dealt with me motivated by hatred’.67 In explaining his claim, Henne summarised his experience as a (putative) leper. His initial

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motivation for coming to be examined was that he was avoided by people, and became depressed in consequence. Having been diagnosed with leprosy in Frankfurt, he duly returned to Ursel and reported this to his friends. Subsequently, people began to associate with Henne again; for this reason, he came to doubt the diagnosis, and so went to Cologne for a second opinion. This letter illustrates at least four interpretations of leprosy:  that of the Frankfurt physicians, that of those in Cologne, that of Henne himself and that of his social circle. The committee refused to pay costs and damages, stating that they had done their duty in good conscience. These and the Lepraschau’s other extant letters show a process of social diagnosis for leprosy, as well as its medical diagnosis. We see that these separate diagnostic processes might exist in tension, indeed in conflict. Evidence of communal concern for those suspected of having leprosy comes from an undated letter concerning a religious woman from Blankenau.68 The letter was sent on behalf of the entire community and its named officials; they beg ‘the honourable council of Frankfurt, our very good friends’ for a verdict. It is specified that the unnamed woman had been with the convent a long time, suggesting the existence of strong emotional and social ties between her and her community. ‘She is so weak’, the letter runs, ‘that we are worried that she might be unclean, and it might then be a difficult thing for her to live among us (as we have been informed)’.69 This letter poignantly evokes the concern of a community for one of its members, and demonstrates that such concern could be handled by becoming informed (unddericht) about symptoms and causes of disease before appealing to the professional physicians in Frankfurt. The convent community held council together, and sent the woman to Frankfurt to be examined. The letter they sent with her is rich in evocative detail: Once more we earnestly beg you, for God’s sake, and by the will of our entire community here assembled, that you help our Brother Hans, whom we have sent out in good faith to accompany the virgin to the masters for inspection. Your honours may truly judge that we are honest, and beg you to be merciful, and pay what is owed to the masters. For she is poor, and her friends are poorer, and she has no help from anyone. Our cloister, too, is impoverished, and has several poor young women who do not have any other means of support;

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our common alms are used exclusively by the sick. Therefore we beg your honours, that you will do all of your best in this matter, since we place our entire faith and trust in you. And we will repay this with the earnest prayers of our whole community for you, day and night.70

This request offers a glimpse at a perception of the practice of medicine as simultaneously professional and charitable, qualities that have been too often represented as competing with each other in the late medieval care of the sick.71 The language of the examiners, as well as that of their supplicants, was attuned to the emotional and social experience of disease, in addition to its medical manifestations.

Conclusion Taken together, prescriptive hospital statutes, records concerning hospital practice and Lepraschau letters reveal diverse responses to lepers and leprosy in the late medieval Rhineland. Moreover, the social effects of a diagnosis of leprosy were variable. As revealed by hospital documents, those identified as leprous continued to be connected to their neighbours, friends and family members, in ways not solely determined by their diagnosis. The location and social function of leprosaria were determined not primarily by attitudes towards the disease, but by hospitals’ status as religious institutions. This religious status was shared by the hospitals’ residents, both healthy and sick. The agency of the leprous themselves is revealed in the fact that they might seek to live in informal communities, without the privileges of religious status, but also without its restrictions. Lepers within hospitals were most commonly known as good people (guden leuden), while those in less permanent groupings appear often as the poor children of God. It is the latter who seem to have been the group most distinctively defined as lepers, without the legal privileges of religious status, not necessarily having obtained any formal diagnosis, and primarily dependent on alms. They might also appear as the ‘armen siechen ausgesetzt’, the poor sick set apart. As both hospital rules and Lepraschau letters reveal, however, such ‘setting apart’ could be narrowly defined and even customised, limiting certain types of social interaction, but not enforcing full segregation. The lepers

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of the Rhineland appear not only in groups, but as individuals  –​ seeking or disputing medical diagnosis, receiving gifts or receiving care, wandering about or doing their shopping –​good people, poor sick, and active participants in late medieval communities.

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Notes 1 I am indebted to the Fulbright Commission for funding the research that enabled the production of this paper, to Dr Elma Brenner and Dr Anna M. Peterson for inviting me to present an early version of it at the 2016 International Medieval Congress at Leeds, to Dr Elizabeth Kuhl Nevitt for reading a draft, and to the external reader of this volume for helpful comments. All errors and omissions are, of course, my sole responsibility. 1 Touati, Maladie, p. 19: ‘Pour bien des esprits, le Moyen Âge, c’est la lèpre.’ See also F.-​O. Touati, ‘Histoire des maladies, histoire totale? L’exemple de la lèpre et de la société au Moyen Age’, Sources et travaux d’histoire haut-​pyrenéenne, 13 (1988), 3–​14, esp. 3–​5. J. Orlemanski, ‘How to kiss a leper’, postmedieval: A Journal of Medieval Cultural Studies, 3 (2012), 142–​57 (pp.  146–​8), points out that the medieval ‘leper’ has come to incorporate the grotesque embodiment of historical otherness. 2 R. Gilchrist, ‘Christian bodies and souls:  The archaeology of life and death in later medieval hospitals’, in S. Bassett (ed.), Death in Towns:  Urban Responses to the Dying and the Dead, 100–​ 1600 (Leicester:  Leicester University Press, 1992), p.  103, says that leprosaria were ‘isolation hospitals which provided permanent accommodation for sufferers, and fulfilled a general social purpose by segregating a stigmatised group’. C. Peyroux, ‘The leper’s kiss’, in S. Farmer and B. Rosenwein (eds), Monks and Nuns, Saints and Outcasts: Religion in Medieval Society (Ithaca, NY: Cornell University Press, 2000), pp. 172–​88 (p. 174), claims that the diagnosis of leprosy was followed by the diagnosed person being ‘rhetorically, socially, and in some places juridically separated from humankind in an act that imaginatively excised the leprous from full concourse with the body of Latin Christendom. The rhetoric that supported the exclusion of such individuals from full participation in society construed their continued existence as at best a tolerable calamity and at worst a pernicious threat to the common good.’ On medieval stereotypes, modern stigma and the social identities of those diagnosed with leprosy, see C. Roberts, Chapter 1 in this volume.

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3 F.-​O. Touati, ‘Les léproseries aux XIIème et XIIIème siècles:  Lieux de conversion?’, in N. Bériou and F.-​O. Touati (eds), Voluntate Dei leprosus:  Les lépreux entre conversion et exclusion aux XIIème et XIIIème siècles, Testi, Studi, Strumenti, 4 (Spoleto: Centro italiano di studi sull’Alto medioevo, 1991), pp. 1–​32, suggests that the sermons of Jacques de Vitry were designed to give lepers a sense of communal identity. E. Brenner, ‘Outside the city walls:  Leprosy, exclusion, and social identity in twelfth-​and thirteenth-​century Rouen,’ in M. Cohen and J. Firnhaber-​Baker (eds), Difference and Identity in Francia and Medieval France (Farnham: Ashgate, 2010), pp. 139–​55 (pp. 139–​41), argues for a nuanced understanding of lepers’ identities, asserting that while lepers were defined as a distinctive group, the actual and symbolic boundaries of group identities were intentionally fluid in thirteenth-​century Rouen in order to promote urban cohesion. 4 J. Imbert, Histoire des hôpitaux français:  Contribution à l’étude des rapports de l’église et de l’état dans le domaine de l’Assistance Publique. Les hôpitaux en droit canonique (du décret de Gratien à la sécularisation de l’administration de l’Hôtel-​Dieu de Paris en 1505) (Paris: J. Vrin, 1947), p. 37, deplores the fact that leprosaria failed to deal with the ‘scourge’ of leprosy, instead simply providing residents with food and clothing as other hospital types did. See also F. Irsigler, ‘Matriculae, xenodochia, hospitalia und Leprosenhäuser im Frühmittelalter’, in M. Pauly (ed.), Einrichtungen der sozialen Sicherung im mittelalterlichen Lotharingien:  Actes des 13es Journées Lotharingeinnes (12–​15 Oct. 2004) (Linden: Section Historie de l’Institut Grand-​Ducal, 2008), pp. 323–​38. On the religious status of leprosaria and the implications of this status, see also E. Brenner, Chapter 6 in this volume, pp. 161–2. 5 S. Roffey, Chapter  5 in this volume, discusses the difficulties of studying such communities from an archaeological perspective (p. 134) L. Demaitre, Chapter  8 in this volume, discusses the need for further investigation of the leprous outside hospitals, p. 232. 6 A. Schelberg, ‘Unification des recherches sur la lèpre et les lépreux sous le nom de “léprographie”? Une réponse’, in B. Tabuteau (ed.), Lépreux et sociabilité du Moyen Age aux temps modernes (Rouen: Publications de l’Université de Rouen, 2000), pp. 93–​8, notes the necessity –​and difficulty –​of crafting a sophisticated vocabulary for interdisciplinary approaches to the study of medieval leprosy. 7 For a discussion of medical and social models of medieval leprosy, see Rawcliffe, Leprosy, pp. 13–​43. S. Ell, ‘Blood and sexuality in medieval leprosy’, Janus, 71 (1984), 153–​65 (p. 155), is unusually categorical in his assertion that medieval diagnosis of leprosy was conservative and that no other disease was connoted by the term lepra.

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8 For an overview, see F.-​O. Touati, Chapter 2 in this volume, pp. 46–8. 9 B. Laqua, Bruderschaften und Hospitäler während des hohen Mittelalters:  Kölner Befunde im westeuropäisch-​vergleichende Perspektive (Stuttgart:  Hiersemann, 2011), pp. 109–​ 13. Marburg, Hessisches Staatsarchiv (HStAM), Urkunde 47, no.  38, provides an example from the leper hospital of Kassel, describing its sick as ‘leprosi et infirmi’. On the definition of infirmi, see J. Agrimi and C. Crisciani, ‘Charity and aid in medieval Christian civilisation’, in M. D. Grmek (ed.), Western Medical Thought from Antiquity to the Middle Ages (Cambridge, MA: Harvard University Press, 1998), pp. 170–​96 (170–​6). D. Le Blévec, ‘Infirmes et infirmités dans la société médiévale, d’après les sources méridionales’, in F. Collard and E. Samama (eds), Handicaps et sociétés dans l’histoire: L’estropié, l’aveugle et le paralytique de l’Antiquité aux temps modernes (Paris:  L’Harmattan, 2010), pp.  145–​ 56 (p. 146), describes the leprous as ‘infirmi par excellence’. 10 Demaitre, Leprosy, pp. 81–​3; U. Knefelkamp, Das Gesundheits-​und Fürsorgewesen der Stadt Freiburg im Breisgau im Mittelalter (Freiburg im Breisgau:  Herder, 1981), p.  54; T. S. Miller and J. W. Nesbitt, Walking Corpses: Leprosy in Byzantium and the Medieval West (Ithaca, NY:  Cornell University Press, 2014), pp. 32–​43. Rawcliffe, Leprosy, pp. 72–​8, offers a survey of leprosy in ancient and medieval medical texts. On misellus, Demaitre argues in Chapter 8 in this volume that it was a term of endearment, p. 208. 11 G. Dethlefs, ‘650 Jahre Kinderhaus’, in R. Toellner (ed.), Lepra  –​ Gestern und Heute:  15 wissenschaftliche Essays zur Geschichte und Gegenwart einer Menschheitsseuche. Gedenkschrift zum 650-​jahrigen Bestehen des Rektorats Münster-​Kinderhaus (Münster:  Regensberg, 1992), pp.  14–​27 (14, 17–​18), asserts that ‘Kinder was a common term for medieval lepers, but comparative evidence from further up the Rhine suggests that it was only so in certain regions of the Rhineland.’ Mainz, Stadtarchiv (StAM), U/​1366 März 23; StAM, 33/​1, fo. 2r; StAM, 13/​231, 49–​50; Darmstadt, Hessisches Staatsarchiv (HStAD), A2 168/​527. 12 See Brenner, Chapter 2 in this volume. 13 See C.  Roberts, Chapter  1 in this volume, for opposition to this approach, p. 39. Demaitre, in Chapter  8, chooses the alternative of leaving terms untranslated. 14 A. M. Peterson, Chapter 11 in this volume, p. 324. 15 For further on the internal regulation of leprosaria, and the medical and religious aspects of the same, see Brenner, Chapter  6 in this volume.

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16 G. Risse, Mending Bodies, Saving Souls:  A History of Hospitals (Oxford:  Oxford University Press, 1999), pp. 167–​72, describes the diagnosis of leprosy by medieval physicians as a dehumanising and uncompassionate process, with communal shaming and/​or suspicion as its catalyst. C. A. Roberts, ‘The antiquity of leprosy in Britain: The skeletal evidence’, in C. A. Roberts, M. E. Lewis and K. Manchester (eds), The Past and Present of Leprosy:  Archaeological, Historical, Palaeopathological and Clinical Approaches (Oxford:  Archaeopress, 2000), pp. 213–​22 (pp. 214–​15), noting the low percentage of visibly affected skeletons in hospital cemeteries, suggests that lepers may have been accepted in the community despite their disease; that diagnosis may have been inaccurate; or that people may have concealed their disease ‘because they knew their lives would be over’ once they entered a leper hospital. S. Roffey sounds a more moderate note in ‘Medieval leper hospitals in England:  An archaeological perspective’, Medieval Archaeology, 56 (2012), 203–​33. 17 Demaitre, Leprosy, pp. 67–​74, 175–​95, provides a brief discussion of the Lepraschaubriefe (leprosy diagnosis letters), which I will examine in detail here. His is a lone voice arguing that when literary texts register repulsion, fear or compassion in response to lepers, they do so on grounds of the disease’s disfiguring effects, not its contagious potential or its social stigma. See also F. Dross and A. Kinzelbach, ‘ “Nit mehr alls sein burger, sonder alls ein frembder”:  Fremdheit und Aussatz in frühneuzeitlichen Reichsstädten’, Medizinhistorisches Journal, 46 (2011), 1–​23. Miller and Nesbitt, Walking Corpses, 1–​ 3, offer one of too few discussions of how the visible symptoms of lepromatous leprosy may have affected interpretations of the disease by medieval physicians, theologians and hospital donors, paying more detailed attention to medical realities and medical vocabulary than is the norm among social histories of medieval medicine. Demaitre, Chapter 8 in this volume, discusses the visual iconography of ‘lepra’ as a medieval cultural phenomenon. 18 P. Richards, The Medieval Leper and His Northern Heirs (Woodbridge:  Boydell Press, 2000), pp. 31–​ 2 et passim; R. Jütte, ‘Stigma-​ Symbole:  Kleidung als identitätstiftendes Merkmal bei spätmittelalterlichen und frühneuzeitlichen Randgruppen (Juden, Dirnen, Aussätzige, Bettler)’, Saeculum, 44 (1993), 65–​89, creates a typology of stigma identification through clothing. The chief problem with Jütte’s contention, in my view, is that he assumes that the clothing of lepers must always have been both intended and recognised as a stigmatising identification. S. Zimmerman, ‘Leprosy in the medieval imaginary’, Journal of Medieval and Early Modern Studies, 38 (2008),

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559–​87 (561), argues that leprosaria afforded ‘a curious mixture of protection and humiliation’. 19 On the religious functions of leprosaria, and perceptions and patronage of them as religious institutions, see C.  Rawcliffe, Chapter  4 in this volume. 20 Urkundenbuch Speyer, no. 98. Stadtarchiv Speyer (StASp), III 122–​3 B, fo. 281r, appends a letter of papal privilege, almost certainly issued by Boniface VIII, in response to the Council of Vienne. 21 StASp, III 122–​3 B, fo. 281r: ‘Bonifacius Episcopus servus servorum dei, dilectis fillis magistro et fratribus Hospitalis Leprosorum Sancti Nicolai Spiren: salutem et apostolicam benedictionem. Solet annuere sedes apostolica piis votis et honestis petentium precibus benevolum favorem impartiri, qua propter dilecti in Domino filii vestris gustis postulationibus grato concurrentes assensu omnes libertates et immunitates a predecessoribus nostris Romanis Pontificibus sive per privilegia vel alias indulgentias vobis et hospitali vestro concessas nec non libertates et exemptiones secularium exactionum a regibus principibus vel aliis christi fidelibus rationabiliter vobis et hospitali predicto indultas sicut eas juste et pacifice possidetis nobis et per nos eidem hospitali vestro auctoritate apostolica confirmamus et presentis scripti patrocinio communimus. Nulli ergo omnino hominum liceat hanc paginam nostre confirmationis infringere vel ei ausu temerario contrarie.’ 22 On the leprosarium at Pontoise, see Brenner, Chapter  6 in this volume, pp. 169–70. L. Le Grand (ed.), Statuts d’hôtels-​Dieu et de léproseries: Recueil de textes du XIIe au XIVe siècle (Paris: Alphonse Picard et Fils, 1901), pp. 184–​98, 217, 225, 236, 238–​9. The late-​ twelfth-​century rule for the leper hospital of Meaux enjoins punishment for ‘going into towns and taverns’ (a telling plural!) without permission. Similarly, at Châteaudun (1205), the master’s permission was necessary to exit the claustrum of the lepers. At Noyon, eating or sleeping outside the hospital without the permission of the master was to be punishable by a penance, and lepers were not to mingle with the healthy except by invitation. At Chartres, the penalty for a healthy person eating with a leper was to go without wine for one day; the same punishment was meted out to lepers who invited guests. 23 Cf. S.  C. Watson, ‘Fundatio, ordinatio, and statuta:  The statutes and constitutional documents of English hospitals to 1300’, D.Phil. dissertation (University of Oxford, 2003), pp. 189–​239; E. Jeanselme, ‘Comment l’Europe, au Moyen Age, se protégea contre la lèpre’, Bulletin de la Société Française d’Histoire de la Médecine, 25 (1931), 116–​24.

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24 StAM, 32/​700 and StAM, 32/​702 show Saint Georg’s records copied out in the fifteenth century and actively edited and annotated. In the late fifteenth century, Speyer’s leprosarium offered loans in partnership with the cathedral chapter:  Bistumsarchiv Speyer (ABSP), 56–​7, 59, 68. StASp, III 122–​3 B is the account book of the leprosarium, put together in the sixteenth century and containing copies of many medieval documents. 25 For use of the leper hospital as a geographical marker, see H.  Boos (ed.), Urkundenbuch der Stadt Worms, Vol. I  (Berlin:  Dunker & Humblot, 1890), Charters 235, 238, 240, 271. For comparative secondary references, see K. A. Schaab, Geschichte der Stadt Mainz, Vol. III (Mainz: Kupferberg, 1851), p. 413; Karl Baas, Mittelalterliche Gesundheitsfürsorge im Gebiet des heutigen Rheinhessens (Berlin:  Richard Schoetz, 1931), pp. 34–​ 6; E. Hinkel, Das Gau-​ Algesheimer Hospital:  Beiträge zur Geschichte des Gau-​Algesheimer Raumes (Gau-​ Algesheim: Carl-​ Brilmayer-​ Gesellschaft, 1987), p.  1, for a regional pattern of hospital foundations along the Rhine in the late thirteenth century. M. Matheus, ‘Vom Bistumsstreit bis zur Mainzer Stiftsfehde: Zur Geschichte der Stadt Mainz 1328–​1459’, in F. Dumont, F.  Scherf and F.  Schütz (eds), Mainz:  die Geschichte der Stadt (Mainz: Phillip von Zabern, 1998), pp. 171–​204 (pp. 178–​81), emphasises the close social and economic ties among the great episcopal cities of Mainz, Worms and Speyer. For economic transactions between the leper hospital of Worms and other parties, see UB Worms, Vol. II, 15, 22, 112, 156, 195, 401, 442. 26 Stadtarchiv Worms (StAW), Abt. 1 AI Nr I-​0364: ‘Wie das die armen ußgesetzten suchen die bis here in unser Stad hoff an der Spirer Strasse gewest sin beide manne und frauwen die wile umb gotes willen ußer unser Stad und auch von dem lande den eingenommen haben groß ungehorsam unseren und unsers Rates Meistern und des houes Schaffnern getan haben und wie sie groß Zwietracht misschelle und unredlich verbundnis untereinander in dem houe gemacht und sich auch an Straßen uff dem Lande und in unser Stadt als ußgesetzte arme siechen nit gehalten noch getragen haben.’ 27 Ibid. On anxieties concerning food contamination, see Brenner, Chapter 6 in this volume, pp. 172–4. On the use of clappers by those diagnosed with leprosy, see Demaitre, Chapter 8 in this volume. 28 StAW, Abt. 1 AI Nr I-​0364. In addition, the possibility that the sick residents will resist leaving the hospital after being declared healthy is foreseen. 29 G. Geltner, ‘Social deviancy:  A medieval approach’, in C. Chazelle, S. Doubleday, F. Lifshitz and A. G. Remensnyder, (eds), Why

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the Middle Ages Matter:  Medieval Light on Modern Injustice (New York: Routledge, 2012), pp. 29–​40 (pp. 31–​4). For comparison of hospital rules, see also Le Grand, Statuts. 30 StAM, U/​1379 Mai 14. 31 Ibid.; HstAD, A2 168/​ 527; Frankfurt, Institut für Stadtgeschichte, Frankfurt Sanitätsamt (Frankfurt Sanitätsamt), Akten des Rats (Medicinalia), 160, 164, 171, 175. 32 Support of this view is offered by StAM, U/​ 1431 Sept. 19  –​the testament of a widow including several hospitals, and the chapel; the document survived in the possession of the leper hospital. R. Heuser, Namen der Mainzer Straßen und Örtlichkeiten: Sammlung, Deutung, sprach-​und motivgeschichtliche Auswertung (Stuttgart: Franz Steiner Verlag, 2008), p. 240, mistakenly identifies the chapel of Saint Georg as being within the hospital complex outside the Gautor, although the main hospital would certainly have had its own chapel. 33 For the political upheavals of Mainz in the 1460s and 1470s, and their consequences for the city’s religious institutions, see K.-​M. Sprenger, ‘Die Mainzer Stiftsfehde 1459–​1463’, in Dumont et  al., Mainz:  Die Geschichte der Stadt, 205–​25. 34 StAM, 32/​704. 35 F. Dross, ‘Their daily bread: Managing hospital finances in early modern Germany’, in L. Abreu and S. Sheard (eds), Hospital Life:  Theory and Practice from the Medieval to the Modern (Bern:  Lang, 2013), pp. 49–​66, is exceptional in its analysis of the agency of a hospital community. 36 StAM, 32/​700. The legal rights of medieval lepers have long been a subject of scholarly interest. The conclusion that lepers had virtually no rights, either in secular or ecclesiastical law, is particularly common for those working with prescriptive texts or literary sources. P. H. Cullum, ‘Leperhouses and borough status in the thirteenth century’, in P. R. Coss and S. D. Lloyd (eds), Thirteenth Century England, Vol. III:  Proceedings of the Newcastle upon Tyne Conference 1989 (Woodbridge:  Boydell Press, 1991), pp. 45–​ 6, argues that the foundation and upkeep of leprosaria formed a safety net for lepers, who had few legal rights. M. Uhrmacher, Leprosorien im Mittelalter und früher Neuzeit, Geschichtlicher Atlas der Rheinlande, Beih. VIII/​ 5 (Köln:  Rheinland-​ Verlag, 2000), pp. 1–​ 12, and D. Angers, ‘La bourgeoisie de Falaise et ses lépreux à la fin du Moyen Age’, Florilegium, 6 (1985), 217–​18, demonstrate that lepers’ rights could be variable and conditional. 37 StAM, 32/​ 700, 25. The term ‘feltsieche’ may be translated as ‘wandering leper’ or simply ‘a leper in the fields’, as contrasted with one in a hospital.

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38 The existence of such informal groupings of lepers has sometimes been stated as a truism, but has not been analysed in detail. D. Jeanne, ‘Le groupe de lépreux de Saint-​ Lazare de Falaise’, in B. Tabuteau (ed.), Lépreux et sociabilité du Moyen Age aux temps modernes (Rouen: Publications de l’Université de Rouen, 2000), pp. 39–​61 (pp. 39–​41), hypothesises a transition from such institutional informality to official ‘foundation’ in the twelfth century. While such a pattern may have been followed in the formation of many leprosaria, other informal communities did not become incorporated as religious institutions. C. P. Lewis, ‘Framing medieval Chester: The landscape of urban boundaries,’ in C. A. M. Clarke (ed.), Mapping the Medieval City: Space, Place, and Identity in Chester c. 1200–​1600 (Cardiff: University of Wales Press, 2011), pp. 50–​2, notes that leprosaria were more often situated at crossroads, or along busy thoroughfares, than at boundaries, and that more work is needed on this topic. See also M. Uhrmacher, Lepra und Leprosorien im rheinischen Raum vom 12. bis zum 18. Jahrhundert (Trier: Porta Alba Verlag, 2011), pp. 105–​12. 39 StAM, 33/​1, fo. 2, the 1315 account book of the Heilig Geist Spital, uses the community as a point of topographical identification: ‘Anderwerbe hat der spidal einen morgen zu Kastelle uf dem smalen wegen der da zughet [sic] in die sehen morgen bi des walpoden Kinder.’ HstAD, C1 A  Nr. 89, fos 10v, 138v–​139r, the cartulary of Saint Agnes (the independent house founded by the religious women forced out of the Heilig Geist Spital in 1259), also uses the ‘Walpoden’ as a point of orientation. StAM, 13/​231, 269, the cartulary of the canonry of Saint Johannes, confirms that the community remained in the same location, identifying it as near the properties of the Heilig Geist Spital and Saint Agnes:  ‘Item unum juger aput dominas Sancte Agnetis. Item unum duale an der auwanden bij der walpoden. Item drittehalb morge bij dem spidel off dem stolre wege’. The women of Saint Agnes managed a hospital of their own, the so-​called ‘new hospital’ of Saint Alexius. 40 StAM, 33/​1; HstAD, A2 168/​322. 41 StAW, Abt. 1 AI Nr I-​0364. The community responsible for Mainz’s ‘new hospital’, a multipurpose institution, also invested in a dedicated bake-​house for their community: HstAD, C1 A Nr. 89, fos 59v–​60r. The legal rights were acquired in 1358. 42 HstAD, A2 168/​527 (18 January 1384) describes a property as ‘uber den weg zum heiligen Cruze und by den maledern gelegen’. The same record describes multiple hospital properties as adjoining each other, suggesting the possibility of shared use. The Spitalmeister of Saint Alban appears as the unnamed holder of multiple properties, one bordering that of Saint Katherine and the Heilig Geist Spital in Laubenheim, and one ‘zum Druseloch’ (unidentified) between property held by the abbot

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of Saint Jacob and by the lepers (‘den guden Luden geforch’). Whether these lepers are those of Saint Georg or another group is uncertain. 43 Property references are found in HstAD, A2 168/​527 (18 January 1384); StAM, 33/​2 69, 72, 89; HstAD, A2 157/​13. 44 StAM, U/​1458 Feb. 22 describes Fulhen and Kette as ‘wonhaftig zu dem heylgen Crutzen by Mentze gelegen’. The creation or formalisation of a community of canons on this site in the later decades of the fifteenth century is beyond the scope of this chapter, but the vocabulary of the earliest documents relating to that community suggests at least some continuity in care for the sick poor: see StAM, 13/​190. 45 See A. E. Lester, ‘Crafting a charitable landscape: Urban topographies in charters and testaments from medieval Champagne’, in C. Goodson, A. E. Lester and C. Symes (eds), Cities, Texts, and Social Networks, 400–​ 1500:  Experiences and Perceptions of Medieval Urban Space (Farnham: Ashgate, 2010), pp. 125–​48. 46 StAM, U/​1458 Feb. 22. Fulhen and Kette give ‘yr ecker by den guden luden und ußwenig der lantgeweer | Mentz vorgenant gelegen’, then from Heilig Kreuz by the Ebersheimer Weg, ‘unden Hentzen zu den guden luden oven den dumherren’ and ‘oben Heinzen zu den guden luden unden furstenberger’. Near the village of Bretzenheim they give properties on the Bretzenheimer side ‘zu gevor oven dem heilgen geist unden zu der gastmeisterien’, and between Saint Alban and ‘dy strasse gevor unden dem heiligen geyst’. Moving towards Laubenheim, they have properties between those of a nobleman and those of lepers: ‘bevor Juncker Rynck oben zu, under zu den guden luden’, and heading from Heilig Creutz to Laubenheim ‘gevor den guden luden’ 8 acres. They finish the inspection where they began, bordered by Heynzen zu den Guden Luden and the Scholtheißen at Heilig Kreutz itself. 47 On Köln and Aachen, see Uhrmacher, Lepra und Leprosorien, pp. 21, 116–​17; A.  H. Murken, ‘Die Geschichte des Leprosoriums Melaten in Aachen vom Mittelalter bis zum Beginn der Neuzeit:  300 Jahre geschlossene Anstaltspflege für die Aussätzigen’, in Toellner, Lepra  –​ Gestern und Heute, pp. 48–​56. 48 StAW, Abt. 1B Nr 2011, fo. 34r; StAM, 33/​2, 76, 82; StAM, 34/​702, 5–​8, 11, 13–​14; StAM, 34/​700, 10, 14–​18, 20, 25, 31–​32; StAM, U/​1431 Sept. 19 and StAM U/​1450 March 17 record annual gifts to Saint Georg; StAM, U/​1421 Sept. 18 contains a donation to the leper hospital of Oppenheim where the term ‘good people’ is used metonymically for the hospital itself: ‘Das dritte deile zu Spisunge der Armen siechen zu den guden luden by Oppenheim’. Karl Heinz Henn, ‘Mittelalterliche Spitäler in Ingelheim:  Krankheiten und Nöte lassen 3, Standesschranken fallen’, Heimat am Mittelrhein, 47 (2002), 2–​

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records a use of the term in Ingelheim, where the hospital functioned as a point of orientation, as in larger cities along the Rhine. 49 See Peterson, Chapter 11 in this volume. 50 StAM, 13/​ 287, fo. 32r. Property supporting the altar of Saint Vincent, at Mainz’s prosperous Liebfrauen foundation, is described as bordering ‘den guden leuden’ and ‘den guden leuden zu Menctz.’ The double description may denote different groups, or different properties belonging to the same group; fo. 16r–​v provides a detailed description of Saint Georg’s location and properties, suggesting that it would have been identified by name elsewhere in the cartulary as well, but with different scribes at work it is impossible to make such an inference with certainty. 51 On the religious status of the leprous both within and outside hospitals, see Rawcliffe, Chapter 4 in this volume. 52 This adds some complexity to the early-​ sixteenth-​ century evidence from Frankfurt analysed in Demaitre, Chapter 8 in this volume. 53 A. Kinzelbach, ‘  “An jetzt grasierender kranckheit sehr schwer darnider”:  Schau und Kontext in süddeutschen Reichsstädten der frühen Neuzeit’, in C.  C. Warhmann, M. Buchsteiner and A.  Strahl (eds), Seuche und Mensch:  Herausforderung in den Jahrhunderten (Rostock:  Universität Rostock, 2010), pp. 269–​ 82. Cf. Demaitre, Chapter 8 in this volume. 54 Demaitre, Leprosy, pp.  241–​ 9, argues for the presence of medical care –​flexibly if not professionally defined –​for leprosy throughout the Middle Ages, contradicting F. Bériac, Histoire des lépreux au Moyen Age: Une société d’exclus (Paris: Imago, 1988). M. McVaugh, Medicine before the Plague:  Practitioners and Their Patients in the Crown of Aragon, 1285–​1345 (Cambridge: Cambridge University Press, 2002), pp. 240–​ 5, cogently observes that medicalisation ought not to be equated with professionalisation, and argues that there is no evidence for a professional esprit de corps to accompany the growing number of medical practitioners and the increasing circulation of medical knowledge, both textually and orally, in the later Middle Ages. 55 Three of the letters concern women; one of those three cases is discussed below. For more on ways in which women’s experience of the Lepraschau was affected by their gender, see L.  Barnhouse, ‘Women’s leprous bodies: Women, doctors, and leprosy examinations in fifteenth-​century Frankfurt’, paper presented at ‘Leprosy and the “Leper” Reconsidered’ conference organised by C. A. Krolikoski and A. M. Peterson, 21 September 2018 (forthcoming in proceedings). 56 On civic examinations, see Rawcliffe, Chapter 4 in this volume. 57 Frankfurt Sanitätsamt, Akten des Rats (Medicinalia), 185.

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58 Ibid., 160. Rupert was a citizen of Frankfurt; the record summarising his examinations is long, faded and well-​nigh illegible; it appears to have been made for the reference of the physicians on his repeated visits. The note reads simply ‘da keyn Trost ist’. 59 Ibid., 175. Both Heinrich and his wife were in poor health; the brother-​ in-​law may have had motive for securing the future of the couple’s shared property, if they were childless. 60 Cf. F. Bergman, ‘Hoping against hope? A  marital dispute about the medical treatment of leprosy in the fifteenth-​ century Hanseatic town of Kampen’, in H. Marland and M. Pelling (eds), The Task of Healing:  Medicine, Religion, and Gender in England and the Netherlands, 1450–​1800 (Rotterdam: Erasmus, 1996), pp. 23–​48. 61 Frankfurt Sanitätsamt, Akten des Rats (Medicinalia), 175: ‘ir wüllent in sünderheit und gemeynde auch under rychen geweldigen armen und an allen andern enden was wesens oder stadts die syn /​thun suchen und erforschen /​den selben mir dem maß messen damit | das den Rychen geweldigen und den armen mit glichem masse gemessen und daz soliche lümont nit alleyn an mir und mynen fründen ußfündig gerechtfertigt und gesmehet werden.’ 62 On the social meanings of disease, see R. Jütte, ‘The social construction of illness in the early modern clinic’, in J. Lachmund and G. Stollberg (eds), The Social Construction of Illness (Stuttgart:  Franz Steiner Verlag, 1992), pp. 23–​38, esp. pp.  24–​6 on leprosy as shaping the collective image of disease; S. Crawford, ‘Introduction’, in S. Crawford and C. Lee (eds), Social Dimensions of Medieval Disease and Disability (Oxford: Archaeopress, 2014), pp. 1–​3. 63 Four of these letters have been edited and translated in L. Barnhouse, ‘Examining for leprosy in the fifteenth century (ca. 1430–​1500)’, in C. Hunt McNabb (ed.), Medieval Disability Sourcebook: Western Europe ([n.p.]: Punctum Books, 2020), pp. 85–​102. 64 Frankfurt Sanitätsamt, Akten des Rats (Medicinalia), 166. 65 Ibid., 167. 66 Ibid., 169. 67 Ibid., 171. 68 Although the letter refers to her as a ‘kuchemeide’, the internal evidence suggests that she was a vowed member of the religious community that sent the letter; ibid., 158. The entirety of the text has been edited and translated in Barnhouse, ‘Examining for leprosy’. See also Barnhouse, ‘Women’s leprous bodies’. 69 Frankfurt Sanitätsamt, Akten des Rats (Medicinalia), 158. ‘Wir Otto Probste, Katherina Eptissin, Katherina priorissin, und die samenunge gemeindlichen des Closters zu Blangkenauwe empbyden unsirs inges

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gebede /​dem Erbern Rad zu Frangkffort unseren besondern guden freunden. und biden um Erberkeit wissen und klagen uch das wir ein ingesyte Jungfrauen unsern kuchemeide eine itzunt lange ziit undir uns geweste ist und die ist swache, das wir besorget eine das sie nicht reine sye, das uns danne gar eyn swere sache were under uns zu wonen /​des sint wir underricht worden.’ 70 Ibid. ‘Wieder biden wir eure Ehrsamkeit flelichen, daz ir umme godes willen, und umme einer ganzen sammenunge willen disen gegenwertigen unsern Bruder mit Namen hans genant beholfen wollt eine den wir indruwen und glauben usgeschigket haben /​das hier mit der Jungfrauen zu den Meistern kume, das sie besehen werde, und eure Ehrsamkeit mögen genossen, das uns wäre [Wahre] werde zugesagt, und ir auch gnädig sy abir icht gebore dem Meister zu geben was sie arme ist und ir freunde elende und keine zuleugnung von nymants haid So ist unser Closter seer notdürftig und habe manche elende arme Jungfrauen under uns ist die keine zuleigunge haben, was alleine der gemeyne almose der sy siche gebruchen hir umb bidden wir eure Ersamkeit und tugent das ir allis euer bestes zu disen sache wollet thune als wir uch (euch?) gänzliche gedruwen und glauben /​das wollen wir mit einer ganzen samenunge geine gode mit unserem gebode flisslichen umb euer Ehrsamkeit verdienen zu tage und zu nacht.’ 71 For a brief overview of the literature see T. Frank, ‘Spätmittelalterliche Hospitalreformen und Kanonistik’, Reti medievali rivista, 11(1) (2010), 79–​118. A. Montford, Health, Sickness, Medicine and the Friars in the Thirteenth and Fourteenth Centuries (Aldershot: Ashgate, 2004), pp. 107–​30, cogently points out that canonical objections to friars engaging in medical practice were raised on the grounds of conflict with religious vows, not as a result of a suspicion or devaluation of medical practice itself.

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The clapper as ‘vox miselli’: new perspectives on iconography Luke Demaitre Est rogo vox miseri: vox importuna: pudoris Prodiga: meroris plena: fauoris egens.1 ‘I ask’ is the cry of the wretched one: the cry is importune, Abounding in shame, full of sorrow, and in want of kindness.

These verses were part of the ‘recommendation of alms and generosity’ by Matthieu de Vendôme (d. 1286), abbot of Saint-​ Denis, counsellor to Saint Louis IX, and regent of France when the incidence of leprosy in western Europe was at its height. The subtle nuances of Latin evaporate in translation but, by the same token, they allow for some liberal adaptation to an exploration of identity as projected and perceived. I have taken the liberty of bending ‘miseri’ to ‘miselli’. Misellus, or ‘little wretch’, was a term of endearment for the leprous beggar, which has direct bearing on my thesis in this chapter.2 Its purpose is to challenge the common view that the ‘leper’s clapper’ was nothing but an instrument for scaring people away, and thereby to protect them from horror as well as infection. In my effort to correct this unhistorical view, I will use the terms leprosus and lepra rather than ‘leper’ and ‘leprosy’. This choice is not intended as a display of pedantry but is motivated by the realisation that the common words ‘leprosy’ and, more problematically, ‘leper’ have acquired many layers of meaning over the centuries. In fact, I hope that a glimpse at the seemingly insignificant clapper will reveal the vast differences between the fluid medieval notions, the labels in modern usage and the specific understanding of what is now called Hansen’s disease. It may be easier to follow the direction of this chapter if I briefly retrace the path that led me to this point. It all began with a

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comprehensive study of the writings of Bernard de Gordon, who practised and taught medicine in Montpellier in the decades around 1300.3 His magnum opus was a manual to which he gave the title Lilium medicine, or ‘The Lily of Medicine’, in which he devoted one of the longest chapters to lepra. The chapter is so revealing on many levels, and it has been cited so frequently from the fourteenth to the twentieth century that it deserves to be assessed in the broadest possible context, or at least in the framework of ancient and medieval medical traditions. Moreover, as any thoughtful reader of Bernard’s observations will discover, his keen insights and, by extension, his rational medicine have more to offer than would appear from most studies of medieval leprosy, which concentrate on the moralisations of poets, preachers and philanthropists. The dual challenge of contextualising the Lilium chapter and broadening the history of lepra drew me into searching for Bernard’s sources, collating his views with those of contemporary physicians and surveying pre-​ modern medical literature on the subject.4 In the process, quite a few puzzling details appeared in the margins, and these wound up in a folder for ‘to do’ projects. One of these seemingly tangential issues proved instrumental in extending the scope of my exploration, and it provided a bridge from medical teaching on lepra to the social treatment of leprosi. The puzzle lay in a trivial textual variation between the Latin Lilium medicine and a Castilian translation that was printed in Seville in 1495. Bernard advised the taking of precautions when having sex with a woman who had been with a leprous man:  otherwise, he warned, one should be prepared for ‘the gourd and the stars’ (‘ad cucurbitam et stellas’). In the Castilian Lilio de medicina, the gourd, or begging cup, remained, as ‘calabaças’, but the stars became word change, from Bernard’s ‘clappers’ (‘tabletas’).5 This one-​ almost poetic suggestion of the open sky to the translator’s casual mention of a particular instrument, opened a new field of enquiry, with a shift in focus from learned concepts to material objects and, further, to concrete responses. It was most surprising to discover the scope and significance of the imagery that gave expression to these responses. Hundreds of images shed light on concepts, attitudes and practices that have been ignored or misconstrued in nineteenth-​and twentieth-​century presentations.6 The copious iconography itself received little systematic attention until 2011, when it became the

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subject of a scholarly monograph, Images of Leprosy, by the art historian Christine Boeckl.7 While breaking new ground, Boeckl’s book is likely to stimulate further revision. It served as a valuable catalyst in my re-​examination of perceptions and portrayals of the leprosus.

The body marks of the leprosus Boeckl focused on early depictions of skin lesions and disfigurements, and on the origin of these depictions in political and religious agendas. She showed a pronounced interest in parallels between the pre-​modern images and the currently recognised manifestations of Hansen’s disease. This fascination provided the author with original insights as well as material for lively dialogue while she was writing her book, and it placed in relief my own approach, which can lay no claim to the perspicacity of the art historian. For better or worse, I endeavour to maintain a clear demarcation between ‘leprosy’ and lepra, and to treat the latter as a medieval phenomenon, concept and cultural ‘construct’. This distinction dovetails with an introductory observation about medieval iconography. It is important to note that bodily marks played a secondary role in representing leprous patients, while they were decisive in portraying victims of diseases such as smallpox or bubonic plague. As early as 1861, Rudolf Virchow, who claimed to have ‘examined hundreds of lepers in Norway’, emphasised that ‘old pictorial representations tell us more about costume and décor than about the appearance and nature of the disease’, and that they ‘are quite useless for diagnostic purposes’.8 Few illustrators included realistic details, and even fewer were primarily concerned with medical diagnosis. The features that identified a body as leprous were primarily symbolic, and they were most commonly reduced to schematic blotches or spots.9 A typical example is found in a thirteenth-​century Greek manuscript that is no doubt modelled on earlier Byzantine art.10 This example is of particular interest because, as it has been presented in an authoritative index, it would be a strikingly unusual illustration of Chapter 13 of Leviticus. It supposedly shows Moses legislating that, when someone was found defiled by lepra, ‘without the camp shall his habitation be’ (Leviticus 13:46). Collation with

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scores of similar images, however, reveals the correct interpretation. The halo of the seated man and, even more telling, a marked difference between the bodies of the central figure and of the others who stay aside, leaves no doubt that this illustrates the gospel story of Jesus being thanked by only one of the ten leprosi whom he had healed –​or, more literally, cleansed (Luke 17:11–​19). One of the numerous analogous illustrations (Figure 8.1), from late thirteenth-​ century Germany, is in the so-​called prayer book of Saint Hildegard. The manuscript drawing emphasises the contrast between the grateful ‘foreigner’ (‘alienigena’) and the nine other men who did not return to say thanks. And yet, paradoxically, the half-​naked men are marked as leprous even though they are clearly on their way to show themselves to the priests as cleansed. This is but one of many instances in which the marks were not intended for the differentiation between health and disease but for the identification of persons. Here and elsewhere, the spots simply but dramatically tagged the characters in the story of the ‘decem leprosi’. Even as dramatic tags, the spots were often highly equivocal. They have led viewers to misinterpret marks that range from the ulcers of Job to the pustules of smallpox and the buboes of plague. It is worth pointing out, in fact, that spots could symbolise suffering in general. This was the case for more than one representation of ‘Behold the Man’ (Ecce homo) as a moment in the Passion of Christ. Spots sometimes even signified martyrdom, as in a late-​ thirteenth-​century Hainault manuscript painting of the stabbing of Saint Quentinus,11 or, more graphically, in a contemporaneous Roman fresco that commemorated the grilling of Saint Lawrence.12 One illustration (Figure  8.2) merits special attention because it demonstrates the multivalent meaning of spots. It is a historiated initial ‘C’ in Omne bonum, the encyclopedia compiled by James le Palmer in England in the third quarter of the fourteenth century. The illumination was originally labelled as ‘Plague victims blessed by priest’ on a digital site of the British Library.13 Taking this caption for granted in 2012, a group of archaeologists featured the image as a poster for their Black Death Network.14 The caption is far off the mark, however, missing even the significant fact that the blessing is being given by a bishop. The image and caption have drawn strong, albeit divided, reactions from specialists in medieval medicine. Some historians see the spots as clear evidence that the

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Figure 8.1  Jesus sends ten cleansed leprosi to the priests, and only one of them returns to say thank you. Note the word ‘alienigena’ at the end of the lower text. Manuscript page in the ‘Prayerbook of Hildegard’, c. 1190.

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Figure 8.2  Bishop blessing four clerics with spots on their faces and hands. Historiated initial ‘C’ of the heading ‘Clericus debilitatus per infirmitatem ministrans quid iuris’, in James le Palmer, Omne bonum, London, c. 1375.

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clerics receiving the benediction were leprous. Others point to the rubric of the section, ‘about the cleric debilitated by illness’, in arguing that the four clergymen’s spots typified disease in general. Their argument finds further support in the juridical context:  a discussion of canon law regarding clerical ministry that began with the basic question, ‘What is illness or disease?’ Whatever the validity of either position, the initial library caption, as well as the ensuing debate, should make us cautious about the reliability of spots or, more broadly, bodily marks as specific indicators of lepra or any other disease. Many other images, moreover, lack a context that can serve as a key to interpretation.

Non-​medical markers The margin of uncertainty about bodily appearance argues for attaching greater weight to additional markers of lepra than is commonly done. These indicators consisted of various implements or symbolic accessories, which become persuasive clues when they appear together. A brief introduction of the principal markers, in ascending order of specific signification, will suffice for our purpose, although each of them opens an avenue for further enquiry. First, a walking aid was a regular accessory of the leprosus, and it represented infirmity as well as, paradoxically, the mobility that was necessary for sustenance and survival. The meaning of this accessory was far from exclusive, however, for a staff might indicate a pilgrim, a cane an old person, or a crutch a cripple. A second type of implement bore an equally multivalent symbolism. It comprised vessels for carrying either drink or alms, and these ranged from a dish to a gourd and a costrel. Such a vessel often symbolised the double grief of infirmity and poverty, but it was also seen on various other persons, from travellers to labourers in the fields. Nevertheless, the beggar’s bowl or cup is poignantly emblematic of the indigent leprosus, the prototypical pauper whom we will encounter in some of the numerous scenes of ‘The rich man and poor Lazarus’. The bowl is central in a tribute by Hans Holbein the Elder to the charity of Saint Elisabeth of Hungary (von Thüringen, 1207–​31). This painting (Figure  8.3), completed in Augsburg in 1516, is noteworthy on two accounts. In a typical demonstration

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of misguided retrospective diagnosis, Rudolf Virchow argued forcefully that the painting depicts ‘both tuberous and macular forms of leprosy’.15 Of more immediate relevance here is the place of this panel in a triptych about three ultimate human afflictions. The artist juxtaposed grinding illness and destitution to the helplessness of the plague victim (represented by Saint Sebastian in the better-​ known central panel) and the fright of sudden death (represented by Saint Barbara in the left panel). Figure  8.3 gives little indication of the clothing by which the leprosus was distinguished in numerous images and in widely diverse ways. In the earliest depictions, leprosi were most often naked or half-​naked. While this may seem an obvious indicator of poverty, it also hearkened back to the biblical injunction, ‘the leper in whom the plague is, his clothes shall be rent’ (Leviticus 13:45). Occasionally, and more subtly, nakedness also suggested helplessness. In many instances, however (including the scenes in Figures  8.4, 8.5 and 8.8), the exposure was clearly intended to give greater visibility to bodily marks. In later depictions, more and more of the body became covered: first the torso, and then the head –​including the mouth in a few remarkable cases –​the lower legs and feet, and even the hands. The last, however, were seldom illustrated, even though municipal authorities across Europe issued ordinances to wear gloves; the clearest illustration was produced in England in the second quarter of the fourteenth century.16 On the whole, depictions of distinctive garb are so variable, and they still allow for so much overlap with other conditions, that they require separate collation before they can yield generalised insights. Suffice it for our purposes that details about clothing will unfold in the images that follow, and that these images will also reveal significant regional differences and chronological changes.17 The most striking variations appear within a category of items that unequivocally pointed to a depicted person as leprous. This category comprises three kinds of instruments with which he or she alerted people, whether in observance of the biblical command to ‘cry, Unclean, unclean’ (Leviticus 13:46) or in an effort to attract merciful attention. We should keep in mind that each of these instruments also played part in musical performances, both festive and ritual. The earliest instrument associated with lepra was the horn, which appears in relatively few documents. One of these (Figure  8.4)

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Figure 8.3  The Charity of Saint Elisabeth, by Hans Holbein the Elder. Right-hand panel, Triptych of Saint Sebastian, 1516. Alte Pinakothek, Munich.

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Figure 8.4  A ‘leprosus’ (so captioned) at the city gate; then healed by ‘Ihesus Christus’. Quill drawing in Rabanus [Maurus, c. 780–856], De Institutione Clericorum. Reims, Carolingian, ninth century.

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is a ninth-​century gospel scene that may have been drawn in the Frankish city of Reims. The cartoon-​like drawing shows a leprosus, so captioned, entering a city gate and subsequently being touched by Jesus. It is worth noting that, while approaching the gate, the leprosus does not announce himself with a sound of his horn but with a gesture that suggests knocking or, perhaps, shouting. The significance of the horn was probably more symbolic and conventional than factual. The combined effect of wandering and illness would have diminished the energy of the leprosus for blowing the instrument –​even when a hoarse shout might still have been possible. Eventually, the ravages of the disease entirely removed the patient’s ability to announce his or her presence vocally. The bell and the clapper were two types of sound-​producing instruments that remedied this problem. The bell appeared in lepra imagery rather late in the Middle Ages, and seldom on the Continent. One of these rare appearances is in an impressive late-​fifteenth-​ century engraving of Saint Elisabeth by Israel van Meckenem (c. 1445–​1503).18 The greater visibility of the instrument in English images may be due to an insular predilection for hand bells that differed from continental cultures.19 Be that as it may, a traditional link between lepra and bell-​ ringing seems to have culminated in a modern watercolour by Richard Tennant Cooper (1885–​ 1957), a painter with a well-​documented taste for the macabre.20 The painting (Figure  8.5) has far broader historical implications than we can pursue here, but it provides a logical transition to our subject. If it had been by a modern Dutch or French painter, the ‘leper’ would have terrified the onlookers not with a bell but, rather, with a clapper. In fact, Sir Henry S. Wellcome, who commissioned the painting around 1910, failed to find a clapper in England and had a replica made for the items that he assembled for his personal collection of historic artefacts, now housed in London at Wellcome Collection (manuscripts, printed books and artworks) and the Science Museum (other types of object).21 Hence, since my exploration here focuses on the clapper, and without underestimating the richness of lepra imagery from medieval England, I will limit my discussion to the Continent.

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Figure 8.5  People Scrambling to Get Away from a Leper, in Their Haste the Crowd has Left an Infant on the Roadside, the Leper Strolls By, Ringing a Bell; Representing Attitudes to Leprosy. Watercolour by Richard Tennant Cooper (1885–1957).

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Unequivocal attribute: the clapper I have compiled hundreds of images of leprosi in a data bank that is substantial enough to support several general observations. In this survey, which is limited to images containing a clapper, I will concentrate on the salient themes and their context, changes and implications. It is helpful to begin with a general idea, projected in the graph of Figure 8.6, of the chronological distribution of images of leprosi with and without a clapper in 300 selected continental images. It may be surprising that both curves peak in the sixteenth century, as this seems to contradict both the consensus among historians that leprosy declined markedly in Europe after the middle of the fourteenth century,22 and the finding of bioarchaeologists that ‘there is extremely little evidence for post-​medieval skeletons with leprosy (1550–​1850 CE)’, as Charlotte Roberts reports in Chapter 1 of this volume. In large measure, however, both peaks in Figure  8.6 are consistent with a continued concern about the disease, and about contagiousness in particular, in the fifteenth and sixteenth centuries: this continuity is evident in scholarly medical texts as well as in the number of official diagnostic examinations that, at the same time, reveal the changing interpretation and expanded application of lepra as a label. Be that as it may, for our purposes the graph shows that the appearance of the clapper begins 100 90 80 32

70 60 50 40 52 30

31

20 10

12

0 S -- XIII

10

24

22 XIV WITH CLAPPER

55 31 XV

30 XVI

XVII

NO CLAPPER; OTHER INDICATORS

Figure 8.6  Three ​hundred images of leprosi –​chronological distribution.

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later and declines sooner than the presence of other attributes. In addition, the changing visibility matches changes in the role of the instrument, which will become clearer in the following pages and illustrations. A sculpture at the Saint-​Pierre Abbey in Moissac, France, which dates from around 1130 (Figure 8.7), is the earliest representation I have found of the instrument that has become commonly known as the ‘leper’s clapper’. It is one of countless dramatisations of the popular Gospel parable of Dives et pauper (Luke 16:19–​31). The rich man of the story, ‘dressed in purple and fine linen, dined sumptuously every day’. He refused to share his bountiful table with a pauper or, more precisely, ‘the beggar named Lazarus, who lay at his door, full of sores’ (‘mendicus nomine Lazarus qui iacebat ad ianuam eius ulceribus plenus’)  –​a sentence so replete with verbal clues that it calls for quoting the Latin version from the Vulgate. Dives wound up in hell, while the beggar was taken into Abraham’s bosom. The Romanesque, sculpted dramatisation of the parable is exquisite, and the part that is reproduced in Figure 8.7 (which omits Abraham and a prophet) could generate pages of comment. For us, the most remarkable detail is the intentionally

Figure 8.7  ‘The rich man and the poor man (Dives et pauper)’. Relief, side wall of the south porch, Saint-Pierre Abbey, Moissac, France.

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emblematic representation of the clapper (in the lower left corner) as an unmistakeable mark of the beggar’s status. Moreover, the sculptor has painstakingly carved the tuberous sores on the arms and legs of Lazarus and, most skilfully, the nodules on his face –​ although this is not the first three-​dimensional depiction of the ulcers or, for that matter, of the spots that conventionally indicated lepra in two-​dimensional art.23 At the risk of seeming to ignore obvious symptoms, I resist the temptation to assess the realism of this relief in a retrospective diagnosis. On the other hand, it is safe to infer that the sculptor intended to mark the beggar with lepra, and even that the sculpture may have been inspired by the status of Lazarus as patron saint of leprosi.24 It is important to point out, however, that many –​possibly most –​dramatisations of the Dives et pauper parable did not depict Lazarus as leprous and thus fall outside our purview. The early date and monastic setting of the Moissac sculpture deepen the intrinsic significance of the depiction, which is further enhanced by its location on the pilgrim road to Compostela. The correlation between lepra iconography and location is a crucial issue, and a part of the broader spectrum of differences in responses that, one hopes, will become the subject of methodical comparison. This volume opens several paths to comparative study of leprosy.25 Suffice it here to give an idea of the spectrum in an overview of Mediterranean, 4%

Netherlands, 25% French, 38%

German, 33%

Figure 8.8  Provenances of 150 continental images with clappers.

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the geographical distribution of clapper images and of regional variations in iconography, while keeping in mind that the pie chart in Figure 8.8 designates areas by language rather than by political boundaries. In any event, the most conspicuous message of the chart is the great quantitative difference between imagery from the Mediterranean and that from the rest of western Europe. I believe that we can still learn much from trying to explain the imbalance between the disproportionate scarcity and abundance of visible leprosi south and north, respectively, of the Alps and the Pyrenees. It is especially puzzling why most Italian and Iberian artists, unlike their northern contemporaries, portrayed the pauper Lazarus without any indication of lepra, and why they almost never showed a clapper. These puzzles dovetail with broader questions about the relationship between the iconographic divergence and the local differences in social structures, cultural norms and disease patterns.

Poor Lazarus Regional variations become pronounced when we tabulate occurrences of the dominant themes. For the sake of tabulation, we may divide the thematic content of 150 images with clappers into four roles in which they cast the leprosus (Figure 8.9). Lazarus plays

Actual, 19% Dives, 32%

Saints, 17%

Jesus, 32%

Figure 8.9  Themes of 150 continental images with clappers.

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the dominant role in the overall assembly, either as the pauper in the parable or as the patron saint of the patients and their carers. The beneficiaries of Christ’s miraculous powers come in a close second, either as single individuals or together with the nine who proved ungrateful. The two other categories are less uniform, and assemble somewhat loosely related items. One group comprises leprous supplicants or wanderers interacting with a saint or saintly figure. An even more heterogeneous fourth category includes depictions of the leprosus in an actual social role, situation, or event; the common bond between such depictions will become clearer shortly, in further illustrations and analyses. The Moissac sculpture augured the steady preference of French illustrators for the story of Lazarus. For three centuries they featured the parable at least twice as often as the healing by Jesus, and they devoted great care to the bourgeois setting and to the distance between rich and poor. The miniature in Figure 8.10, from an early-​fourteenth-​century manuscript of the Bible historiale of Guyart des Moulins, shows the rich man as a crowned king, giving an order to his minister rather than dealing directly with the beggar. The latter’s mendicant status, on the other hand, is emphasised by the redundant phrase, ‘a poor beggar’ (‘uns poures mendians’). Moreover, as the royal minister points out, the man at the door is particularly wretched (‘miser’) because he suffers from lepra. Indeed, the tell-​tale spots mark Lazarus on the face, hands and legs; he needs the support of a crutch; and his attire, though minimal, includes the wide-​brimmed hat of the itinerant leprosus. His mobile stance is at variance –​as it is in many other images –​with his description in the parable as prostrate, and even with the declaration in the nearby text, that he ‘lay at the door’ (gisoit a le porte). The beggar waves the clapper with a gesture of insistence, underscoring his plea for crumbs from the table. These clues converge into an unmistakeable interpretation of the raised clapper as a vox miseri, voicing command rather than alarm. Lazarus is also shown in motion in one of the most unusual French depictions. The illumination in Figure 8.11 was painted in the Tours area around 1500, in a manuscript that was acquired by the British publishing magnate Henry Yates Thompson in 1895, and that thus could conceivably have inspired the melodramatic

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Figure 8.10  Dives et pauper. Miniature by an unknown master, Saint-Omer, 1300–25. In a manuscript of the Bible historiale, which was the first French translation of the Vulgate, completed by Guyart (or Guiard) des Moulins in 1297.

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Figure 8.11  Dives et pauper. Miniature by Jean Poyet, Loire School, c. 1500.

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Wellcome watercolour in Figure 8.5. At first sight, the scene seems to confirm the modern stereotype of the leprous vagrant terrifying the inhabitants of medieval towns. As the beggar advances across the square, towards the house of the dives, he is leaning forwards in a pose that some may read as intimidating. The onlookers keep their distance, and one official-​looking individual covers his nose and mouth. This individual, who may be a steward, is attempting to stand his ground while prodding the dogs to attack. Lazarus, the dominant figure, is portrayed with stunning precision. He is the wanderer, with a wide-​brimmed hat, all his belongings in a satchel, a costrel or beggar’s cup on his belt, and ragged hose. He is also the loathsome leprosus, with deformed hands and a disfigured ‘leonine’ face  –​which physicians indeed ranked as the ultimate sign of lepra. No detail in the scene, however, is more telling than his hands. While holding the left hand out in a begging gesture, he is rattling his clapper to amplify or to replace his vocal cry for succour. Doubts about the role of the clapper here, as ‘the voice of the poor wretch’ (vox miselli), dwindle when one duly considers the context. The painted illumination, which illustrates Psalm 114, surrounds the opening verses, ‘I have loved because the Lord will hear the voice [vocem] of my prayer, because he hath inclined his ear to me.’26 The bottom of the page suggests the fate of those who, like the Rich Man, refuse to hear Lazarus. A most poignant and quite unusual image, shown in Figure 8.12, may further sharpen our precision in assessing the role of the clapper. Conrad von Soest, who created this painting around 1400 in Dortmund, Germany, allotted more space than other artists to the poor man of the parable. Indeed, this is the place for pointing out a chronological dimension. In sharp contrast with the image in Figure  8.12, the figure of Lazarus later on in the fifteenth and sixteenth centuries tended to become secondary in illustrations of the parable, especially when the focus shifted to the opulent banquet.27 Here, in von Soest’s condensed and rather shuffled chronology of the story, Lazarus occupies centre stage. He lies helpless between his own soul in Abraham’s bosom and the rich man in hell. The conventional spots mark his entire body, which is exposed more in the manner of earlier iconography than of contemporaneous depictions, and which is licked by a greater number of dogs than

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Figure 8.12  Dives et pauper. Painting by Conrad von Soest (Dortmund, c. 1370–c. 1422), oil and gold on wood, c. 1400.

in any analogous scene. The clapper  –​which is rarely seen in German iconography of the parable  –​is conspicuously in focus here, a counterpoint to the sumptuous hat of the rich man. Pauper is holding a clapper, apparently still clicking in his weakened hand, and he is directing it straight at the face of dives, who is beseeching him and Father Abraham. Lazarus’s gesture pointedly articulates Abraham’s answer, ‘remember that you received good things in

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your lifetime, and Lazarus evil things’. It is a matter of common sense that a beggar, especially when prostrate, would not be chasing but, rather, beckoning bystanders with any means at his disposal. Hence, the Lazarus portrayals have a built-​in bias that makes it imperative to examine a broader spectrum of iconographic evidence regarding the clapper.

Supplicating Jesus to be cleansed The second largest segment of our database celebrates two encounters between leprosi and Jesus Christ. One, with ten leprous men (Luke 17:11–​ 19), was the subject of Figure  8.1; the other, with one leprous supplicant (Luke 5:12–​ 14, Mark 1:40–​5, Matthew 8:2–​4), is illustrated in Figure 8.4. Both of these encounters accentuate not only the exclusive presence of male leprosi in clapper imagery,28 but also the vast issue of gender, which remains insufficiently explored by historians of early leprosy. It is important to realise that the absence of leprous women holding a clapper cannot be attributed simply to a gender asymmetry in the incidence of the disease, even if the pre-​modern imbalance was more pronounced than in the twenty-​first century.29 In addition to the ‘many factors’ leading to the modern gender disparity in incidence, which Charlotte Roberts outlines in this volume, a range of social and cultural trends contributed to the male dominance in visibility. These trends, furthermore, shaped regional differences and chronological changes in clapper iconography. The complex dynamics in clapper iconography are evident in the partiality of German illustrators, who depicted Christ’s encounters with leprous men much more frequently than the Lazarus parable and, in addition, chose the grouped supplicants rather than the lone leprosus. This preference guides our sampling here, although portrayals of the one-​ on-​ one encounter offer at least as many insights, far beyond what can be gauged from Figures  8.4 and 8.15.30 The German focus on leprosi seeking to be ‘made clean’ by Christ stood in contrast with the more widespread prominence of Lazarus begging the rich man for charity. Furthermore, there is a chronological element in the regional differences, with far-​reaching implications. It is not by accident that the number and intensity of

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the German illustrations peaked later than the French imagery and, most significantly, around the time of the Reformation. One illustration of The Teaching, Life and Passion of Jesus Christ has particular relevance to our theme and the context. Reproduced in Figure 8.13, this woodcut was first printed in Frankfurt in 1517, the very same year that Martin Luther posted his Ninety-​ Five Theses, and it reflects key dynamics of the contemporary drive to evangelical and ecclesiastical reform. In fact, similar prints illustrated many successive editions of Luther’s Explanation, or Auslegung der Episteln und Evangelien, as well as several German versions of the Gospels intended for religious instruction.31 Figure 8.13 offers one more instance of the conventional marking of the disease by spots or, in this case, mere dots on the faces and hands. On a more substantial level, the woodcut incorporates traits that characterised virtually every description of the meeting between Jesus and the leprosi by German commentators as well as by the artists. Even the caption echoes the common exegesis, according to which the meeting resulted in the leprosi being ‘cleansed’ (‘gereynigt’) rather than healed. This literal precision not only hearkened back to Leviticus but also returned to the evangelical Latin (mundantur), away from the medieval interpretations with their increasing emphasis on miraculous healing. The clothing distinguishes the men as leprous wanderers, but it is also reminiscent of the monastic habit and even of pilgrim garb. The itinerant status of the ten leprosi is evident in the illustration from Frankfurt –​and in others from the same area –​as the encounter is staged in the countryside, with a town or burg in the background, often on a hilltop. In contrast, parallel French imagery usually framed the scene in a townscape, just as it did for the Lazarus parable. These observations point to additional values of the Frankfurt woodcut, first, as an incentive for further enquiry into iconographic overlaps between itinerant leprosi and pilgrims.32 This enquiry, in turn, might yield a better understanding of other important yet still neglected issues, particularly the varying status of leprosi outside the leprosarium. In Chapter  7 of this volume, Lucy Barnhouse documents the correlation between the guden leuden (grans malades, hooge zieken) who resided in leprosaria, and the non-​resident armen siechen who appear generally as ‘less formal communities’ (p.  96). A further differentiation of leprosi at large

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Figure 8.13  ‘Ten leprosi are cleansed. Lu[ke] 17’. Woodcut, illustration to Doctrina, Vita et Passio Iesu Christi; formerly attributed to Hans Schäufelein (monogram ‘S’ on shovel, centre below), 1516–17.

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is possible, between hospital residents who were in the streets temporarily, with or without permission, and ‘outsiders’  –​lèpres forains or Feltsiechen  –​whose existence varied from settled to vagrant and from associated to solitary. This variety will become clearer in later sections of the present chapter, when we concentrate on the clapper as a marker of social identity and interaction.33 It is useful to return to the 1517 Frankfurt woodcut for a broader thematic context of the clapper, because it exemplifies distinctive emphases in sixteenth-​century Germanic iconography. Christ dominates the stage with his majesty and authority, which is commonly underscored by his larger stature, radiant nimbus, teaching or blessing hand, ample robe, and entourage of disciples.34 The leprosi approach him in reverent supplication, with hands folded in prayer  –​we will return to the clapper that hangs silent from the right hand of the man in front. A slight depression between both parties underscores the Gospel detail that the ten ‘stood afar off’ (‘steterunt a longe’, Luke 17:12 in the Vulgate). Many German illustrators made the separation more explicit by inserting a gully or even a stream. Their French counterparts tended, rather, to narrow the distance and to show Jesus leaning forward slightly in a posture of compassion. Artists in the Low Countries projected a sensitivity that lay somewhere between German and French accents. I  hope to show in a forthcoming study that the intermediate character of lepra imagery from the Netherlands was consistent with the middle-​ ground position of the area in social and political responses to lepra and other disfiguring diseases. Germanic and Gallic idiosyncrasies co-​exist in several Flemish Gospel illustrations, including one that was painted in Bruges around 1485 (Figure 8.14). In this exquisite manuscript miniature the encounter is staged near the town gate, literally between an urban and a rural setting. Jesus is both magisterial and compassionate, with apostles who act more as animated companions than as stern escorts. He is separated but not distant from the leprosi who, according to the accompanying text, are healed rather than merely cleansed. The ten men are highly individualised and lifelike, but they show no sign of disease. Half of them have their hands folded in prayer (similar to what we saw in Figure 8.13). The viewer’s attention is drawn to the man who, having just arrived, is still removing his hat and, it would

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Figure 8.14  Christ and the Ten Lepers. Miniature in Vita Christi, Bruges, c. 1485.

seem, still shaking his clapper. Another clapper, far less obvious, lies on the ground next to the hat of the man nearest to the viewer; inferentially, this man no longer needs to solicit Jesus’s attention. The illustration in Figure 8.14, especially when it is collated with the 1517 Frankfurt woodcut and also with the many analogous images, hints at the multidimensional –​and evolving –​role of the clapper, as the beggar’s beckoning instrument, a label for identifying a leprosus and, eventually, as we will see, an emblem of special status. One constant in the depictions, however, was the association of pleading rather than warning with the clapper, whether as silent symbol or as wielded instrument. This common thread notwithstanding, the character of the supplicant leprosus was clearly distinct from that of the mendicant Lazarus, and the distinction was rarely bridged. One notable exception is the vignette reproduced in Figure  8.15.35 This manuscript drawing from the last quarter of the fourteenth century, in the Breviari d’amor of Matfré Ermengau of Béziers, is further exceptional because it is one of the scarce medieval lepra

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Figure 8.15  Jhesu christ sana los lebrosos. Christ healing a leprosus. Manuscript drawing, attributed to the atelier of the Catalan Master of Saint Mark, in Matfré Ermengau of Béziers, Breviari d’amor, eastern Spain (Catalonia, Gerona?), last quarter of the fourteenth century (‘1385’).

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representations that were produced south of the Pyrenees.36 To be sure, one might argue that, with a Catalonian provenance, this image may be closer to French or, at least, Aquitanian sensitivities than to Iberian patterns. Be that as it may, the most pertinent aspect is the approach by the leprosus while he is not only wielding his clapper but is also extending his plate. In all other iconography, the combination of appealing for mercy and begging for sustenance unmistakeably identified the poor Lazarus of the parable, rather than the leprosus meeting Jesus. This drawing even seems to suggest an inner contradiction between the beggar’s bowl and, on the other hand, his cowl and shoes, which might belie utter indigence even though they were conventional lepra attire. In another minor inconsistency, Jesus is clearly facing a single individual, but the caption refers to plural beneficiaries, ‘los lebrosos’, either the ten or the many more who accounted for his renown, ‘leprosi mundantur’ (Matthew 11:5). We also note that, according to the caption, Jesus is healing  –​‘sana’  –​rather than cleansing as the Gospels stated and German captions reiterated. The conventional marks of lepra on the supplicant’s body seem understated, to the extent that the reproduction of the drawing allows us to judge. It is clear, however, that the clapper has become the principal tag for identifying a leprosus. In addition, the bowl clarifies, more expressly than in most other images, that he is doubly miserable, as pauper.

Receiving charity from a saint Poverty is at the heart of another image that is exceptional in several respects. An altarpiece in Pescia, in the Italian province of Pistoia, from which a detail is reproduced in Figure  8.16, stands out among the very few scenes from south of the Alps that feature a clapper. Only three such scenes that pre-​date 1500 have come to my attention until now,37 and each of them celebrates the life of Saint Francis of Assisi (1181/​82–​1226). The Pescia altarpiece, painted in the Byzantine style by Bonaventura Berlinghieri of Lucca, dramatises six wondrous events in the life of ‘the poor little’ (il poverello) saint, with emphasis on his charitable deeds. The scene in Figure 8.16 shows Francis distributing alms –​rather than ‘healing’

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Figure 8.16  Saint Francis giving alms. Detail, altarpiece by Bonaventura Berlinghieri of Lucca, 1235, Church of San Francesco, Pescia (province of Pistoia, Tuscany, Italy), tempera on wood, Byzantine style.

as some captions state –​in a rather ornate urban setting. The eight or nine indigents at the centre may be kneeling in supplication, but at least some of them are also crippled, as the hand crutches in the foreground tell us. An unmistakeable emblematic counterpart to these neatly aligned crutches is the clapper in the hand of the next supplicant in line. The erect posture of this man carries an air of nobility, in contrast with the humble expression on his face and in direct contradiction with the staff and costrel (ubiquitous in French art) that mark him as a homeless wanderer.

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The man is further identified as leprosus by the loose cloak and the wide-​brimmed hat, but not by any bodily signs. This becomes directly relevant to our theme when we place the detail in a broader historical context. The Pescia altarpiece was completed in 1235, which makes it the second or third oldest among 150 collated depictions of a clapper. This relatively early date deserves special notice. An obvious inference is that the scene, since it was depicted less than ten years after the death of Saint Francis, is likely to reflect fresh memories of his life.38 Of more direct relevance to our subject is an intriguing coincidence in chronology as well as geography. The same region, namely Tuscany, recorded the earliest known diagnostic verdicts on supposedly leprous patients by physicians, from a time when, elsewhere, such iudicia were routinely administered by clerical, municipal or leprosarium judges. From 1250 in Siena and 1261 in Castiglione del Lago on Lake Trasimene, to 1288 and 1289 in Pistoia, medici issued official judgements on patients that they based on their learned recognition of the true signs of lepra.39 It stands to reason that a member of a thirteenth-​century Tuscan commune would have been aware of the signs of lepra and that an artist would have alluded to them, even in a stylised portrayal and at least in some formal if not clinically precise fashion.40 Berlinghieri’s pronounced focus on the clapper, therefore, suggests that the implement had taken on greater emblematic weight. It became the self-​evident mark of the leprosus who sought that his ‘I ask’ be heard and whose illness, whether visible or not, was somehow secondary to his mendicant status. This symbolism extended beyond the spectrum of distributing alms into acts of charity that combined compassion with humility and asceticism. Saint Francis reportedly overcame both pride and revulsion in his encounters with the poor sick. There were precedents or even models for these victories in the lives of other saints. Saint Martin of Tours (316–​97) is best remembered as the soldier or knight who charitably shared his cloak with a beggar. Some historians have assumed, perhaps too easily, that the beggar is actually presented as leprous in the most familiar depiction of this encounter.41 In another encounter, however, Saint Martin unequivocally and famously embraced a leprosus, whom he healed while entering

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Paris.42 This charitable act was less frequently illustrated but more often imitated (including by Saint Francis) than Martin’s division of his cloak. An artist in fourteenth-​ century Tours dramatised the event in a coloured manuscript drawing, reproduced here in Figure  8.17. The vignette on the right faithfully interprets the anecdote as Sulpicius Severus reported it succinctly (in forty-​one words) in his Life of Blessed Martin.43 The encounter is staged, with remarkable precision, at the city gate, a place where leprosi commonly appear in iconography as well as in literature and ordinances. The bishop of Tours, at the height of his fame, is in full ceremonial attire. He humbly greets the vagabond who carries the sack, staff and costrel on which the wanderer’s life depends. In the intimate act of kissing, the saint’s humility is surpassed by his ascetic victory over the spontaneous revulsion that races through ‘the large crowds around him’. In the words of Sulpicius, ‘all are horrified’ (‘horrentibus cunctis’) by the wandering man’s death-​like and ‘piteous face’ (‘miserabili facie’). Martin’s youthful and smooth face stands in sharp contrast with the facial deformities that mark the leprosus, in this case even more unequivocally than the all-​ covering garb –​which includes a glove. The beggar’s dark glove, a counterpoint to the bejewelled glove on the bishop’s blessing hand, underscores the visibility of the clapper, which juts out, as it were, three-​dimensionally from the picture. The leprosus is holding the clapper in a determined, somewhat awkward and almost ceremonial manner. While his posture seems passive, almost reluctant, in receiving the saint’s kiss, his firmly displayed emblem emphasises a specific status that transcends his poverty and even his illness as such. He is the little wretch, misellus, who should be greeted with a combination of attention, humility and compassion. We may see an impressive echo of this message and even of its artistic formulation in Figure 8.18, a late-​fifteenth-​century painting by Jakob Mühlholzer. The painting adorns an altarpiece by Tilman Riemenschneider in Rothenburg an der Tauber, Germany. It honours Saint Louis of Toulouse (1274–​ 97). The saint is washing the feet of a leprous man while four other poor men are waiting for their turn. Two of these are beginning to remove their footwear, and a staff and markings on hats suggest that at least two are wanderers. Here, too, there is a marked contrast between the faces of the giver and the receiver of the charitable

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act. This contrast is due, at least in part, to the actual youth of this Saint Louis (nephew of the more famous saint, Louis IX of France), who was made archbishop of Lyon at the age of 20. A year later he became a Franciscan friar, taking the grey habit, which is far less ornate than the customary episcopal attire of, for example, Saint Martin in Figure 8.17. In washing the feet, Saint Louis is performing a ritual that parallels both the kiss by Saint Martin and the almsgiving by Saint Francis as a combination of humility, charity and asceticism. Unlike the realistic portrayal of the leprous beggar in Figure 8.17, a certain mannerism in Figure 8.18 cloaks the supplicant’s poverty and stylises his disfigurement –​as was also the case in Figure 8.16, though with a telling stylistic difference. In Pescia, Berlinghieri entirely suppressed the disfiguring features of lepra. In Rothenburg, on the other hand, Mühlholzer reduced them to a facial expression and protuberances on the hands and legs that, while intriguing, are neither clinically indicative nor aesthetically abhorrent. In compensation for this pictorial euphemism, the leprosus holds

Figure 8.17  Saint Martin kisses a leper. Coloured drawing, western France (Tours), third quarter fourteenth century, added into an eleventh-century manuscript of Sulpicius Severus, Vita S. Martini.

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Figure 8.18  Saint Louis of Toulouse (1274–97) washes the feet of a leprosus. Jakob Mühlholzer, c. 1494. Left wing of the altarpiece (by Tilman Riemenschneider), Church of Saint Jacob, Rothenburg an der Tauber.

the clapper as awkwardly and ostentatiously as the beggar being embraced by Saint Martin in Figure 8.17. The clapper, with greater symbolic import than physique or clothing, is clearly the emblem of the misellus here, the voice (vox) asking for compassion.

Dreaded alarm, or call for kindness? The iconography consistently highlights the charitable attention asked for or received by leprosi. There existed, to be sure, an utter perversion of this attention, rooted in deep-​seated fear. Popular prejudice, which was more radical than exclusionary policies, occasionally erupted in outbursts of malice. However, this negative attention is almost invisible in medieval imagery. As a rare exception,

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we have two representations of the most egregious persecution of 1321, in which meseaux across France and Aragon were burned when Kings Philippe V and Jaume II, exploiting unrest and popular paranoia, singled them out as scapegoats.44 Both representations are shockingly direct, and one, reproduced in Figure 8.19, is also particularly germane to our theme. It is a marginal drawing in a French version of a chronicle written by a likely witness to these atrocities, the Dominican friar and Inquisitor Bernard Gui (Bernardus Guidonis, 1261–​1331). In this manuscript, which was produced in Paris almost seventy years after the persecution, the scribe provided the caption on the left, ‘les meseaux qui furent ars’ –​probably before the artist drew the scene in the allotted space. The scribe and the illuminator may have shared the enduring memory, if not censure, of the outrage. Another manuscript painting from the same period and area depicted the execution in dramatic detail, and with an emotional intensity that perhaps indicated remorse.45

Figure 8.19  Meseaux burned alive. Marginal drawing in French translation of Bernardus Guidonis, Fleurs des chroniques, Paris, after 1384.

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In the miniature in Figure 8.19, on the contrary, the onlookers seem rather aloof, although their posture is difficult to interpret. The six victims appear pitiful and pleading, but their expression is also rather subdued while they are seated in the flames. Their faces display the unmistakeable signs of ‘leonine’ disfigurement, and they are fully covered by the conventional garb of leprosi; one is carrying the wanderer’s costrel. Three of the victims are holding up their clappers, as if they want to protect the wood implements from the flames, but more likely they are brandishing them in an attempt to stir compassion. The artist has located the clappers strategically, on three corners of this sad group, so that they might serve as ‘flags’ to identify the bearers. Thus, the miniature draws attention to a less obvious aspect of this identifying function. The more commonly assumed function, namely as an alarm or a mark calling for exclusion, may be compared to that of the badges that were imposed on Jews in medieval Europe. However, the clappers also had a reverse function, which is worth emphasising once more, of appealing for inclusion or at least for charitable attention, almost as if they were ‘merit badges’. The most persuasive evidence for this positive use of the clapper appears in images that document actual situations, as it were, in real time. One of these images, reproduced in Figure 8.20, is particularly arresting on account of its provenance as well as its content. The early-​fifteenth-​century miniature adorns the statutes of the sisters of the Hôpital Notre-​Dame in Tournai, Belgium, which were drawn up in 1238. The precision with which the nun’s habit is drawn, in accordance with descriptions in the statutes, gives reason to attribute a degree of realism to the portrait of the leprous wanderer. The lesions on his face, hands and bare feet are moderate  –​and hardly visible in the reproduction in Figure 8.20 –​so that we might not recognise his condition were it not for the wide-​brimmed hat, the loose frock, the staff and the clapper in particular.46 The setting of this illustration in the statutes of a charitable hospital makes for some pointed historical irony. The image seems to convey an utterly negative message, but the context suggests a more balanced interpretation. At first sight, the nun appears to be denying entry to the man, who is indeed turned as if he is about to leave. This impression fits the

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common emphasis on the exclusion of leprosi from society, and it is initially reinforced by the very text that the miniature illuminates. By order of the hospital charter, ‘The sick who may be suspected of being infected or stained by any kind of lepra should not be accepted in any manner, not even for one single night, but they should stay “outside the dwellings of Israel”, that is to say, beyond the city wall and borders.’ It is impossible to ignore in these lines

Figure 8.20  A sister of the Hôpital Notre-Dame, Tournai, greets a leprous patient. Statutes of the Sisters of the Hôpital Notre-​Dame, Tournai, c. 1400.

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the echoes of Leviticus 13:46, the adumbration of contagiousness or the implications of stigma. The lines that follow, however, point to very different concerns in the statutes: namely, with maintaining the identity of the Hôpital Notre-​Dame, defining jurisdictions and allocating resources. The integral second part of the illuminated paragraph stipulates that suspected leprosi should stay ‘in the place which is intended especially for them: an endowment [rente] is set aside for them, and the alms of good Christians are sent to them daily’.47 This part contradicts the simple interpretation of the nun’s gesture as a denial of charity –​by a member of a charitable order. The stipulation also sheds valuable light on our subject. The leprosus appears neither rejected nor dejected. His dignified stance may belie his wretchedness but, underscored by the clapper in his clenched hand, it presents him as a claimant. He is claiming to be a misellus and entitled to mercy, misericordia. The notion of entitlement endowed the clapper with a powerful significance, and it increasingly transcended the actual condition of lepra or, for that matter, of any identified disease.48 Various poses of men with clappers convey an air of entitlement, but none projects the impression more sharply than the countenance of the person in Figure 8.21. The figure reproduces a detail in a little-​known yet eloquent early-​sixteenth-​century depiction of ‘Christ as Lord of the Beggars and the Sick’, on the back of an altar panel (the Arndorfer Altar) in the pilgrimage church of Maria Saal, Austria.49 The stern profile stands out among fifteen men (here, too, the absence of women is worth noting) who stand, bow and kneel around Christ. The latter, flanked by two angels and presented as ‘The Man of Sorrows’ (‘Ecce Homo’), raises his hands over the men. He is unmistakeably enacting the evangelical declaration, ‘Come to me, all you who are weary and burdened, and I will give you rest. Take my yoke on you, and learn of me; for I  am meek and lowly in heart: and you shall find rest to your souls, for my yoke is sweet and my burden light’ (Matthew 11.28–​30). The tense countenance of the two men in the detail reproduced here stands in contrast not only with the soothing Gospel message but also with the pitiful appearance of the other ‘weary and burdened’ supplicants. It seems reasonable to read the two stern faces as expressing demand or, at least, expectation. This sense is underscored by the slightly forward-​leaning posture of our main figure and, especially,

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Figure 8.21  A leprosus holding a clapper. Detail, back of the Flugelaltar-Predella, known as the Arndorfer Altar, north aisle of the Pfarrkirche, Maria Saal, Carinthia, Austria, 1510–20.

by his clenched right hand. He looks like someone on a quest, and his cape appears to bear the insignia of a pilgrim. A single reproduction affords no certainty for these inferences, however, and it similarly leaves us doubtful about the possible appearance of nodes on his cheeks and hands. The image leaves little doubt, on the other hand, about the emblematic role of the clapper when it is tightly clutched and formally raised –​in a manner reminiscent of several preceding illustrations (particularly in Figures  8.10, 8.15, 8.16, 8.17, 8.19 and 8.20). The clapper clearly serves as a ‘voice’ calling for succour and not as an alarm to scare away bystanders. In this image, moreover, the clapper’s soliciting function is utterly consistent with the fact that the Arndorfer altarpiece was commissioned by a

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charitable fraternity, with the objective of celebrating and inspiring aid to the indigent sick. In the setting of organised charity, and particularly with the development of associations for itinerant leprosi, the clapper became a badge. To be sure, history attests to the double-​edged distinguishing power of a badge, as a mark of merit or a part of stigma. In a somewhat more complex paradox, the clapper functioned not only as a token of neediness but also as an instrument of control, when communities endeavoured to stimulate almsgiving and, at the same time, to check vagrancy. Ironically, while the clapper would have been part of the imposture by individual vagrants, it was ineffectual for controlling the roving bands that reportedly collected alms by extortion.50

Tag and badge The role of the clapper in the exercise of restrictive controls points to social issues that, while deserving further thought, would lead us too far afield here. Suffice it to recall the variety of lèpres forains to whom control might be applied. In addition, this category inevitably opens broader perspectives, of the relationship between town and country, the balance between regulated residence and free mobility, and the boundaries between soliciting and menacing. There were large communes, such as Toulouse and Bordeaux, where the authorities endeavoured to maintain order by enjoining every ladre to carry a clapper. Such efforts were, inferentially, directed at itinerant leprosi. The orders were probably disregarded, for they had to be reiterated, until at least 1578 in Casteljaloux. In Castres, the town fathers expressly forbade any malade to enter the town without carrying ‘the leper’s mark’ (la merque de ladre), which they defined as ‘the clappers and the bowl’ (las tabastells el cabas); they even cited a model for this mark, namely, ‘the way it is done in Toulouse’ (la forme qua fan a Tholosa). In 1595, a Toulouse surgeon indeed echoed a primarily restrictive view of clappers in his city. Guillaume des Innocens observed that ‘ladres’ (a term derived from ‘Lazare’) were ordered to carry ‘cliquailles’, or ‘cliquettes’, so that ‘neighbours, bystanders or others who hear the sound will be warned to get out of the way and to stay far from the path, air, or breath of those poor folks, giving them

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space and, from time to time, alms’.51 Des Innocens believed that one ‘should fear the foul-​smelling and infected breath of ladres’ –​ in other words, that the disease was communicated through the air. A  passing conjecture, however, hinted that contagiousness was primarily a medical issue, ahead of popular awareness.52 He added that, because of the infected breath, as well as the ‘hoarse and difficult voice’, of the ladre, ‘the school of physicians (in my opinion) has invented this kind of instrument [the clapper], for safeguarding the public interest by preventing conversation of ladres with healthy and clean people’.53 The suggestion of a lag between medical learning and common consciousness dovetails with the lack of allusions to contagiousness in clapper imagery, not only for Gospel scenes but also for hagiography, where the heroism of saints lay in overcoming disgust, pride or indifference rather than fear. In addition, the emphasis that des Innocens placed on the ‘safeguarding’ function of cliquettes reflects the reality that protective measures leave deeper impressions than charitable impulses. Similarly, his casual addition of the solicitation of alms –​ as if it were an afterthought –​reminds us that ‘giving’ ranked lower in the concerns of medical practitioners and government officials than in the minds of people and the ideals of pious organisations. The distance between everyday reality and idealised images did not preclude the alignment of power and piety in many regions where authorities, too, viewed the clapper as an instrument for soliciting assistance. They implied this view in a twofold policy that aimed simultaneously at the stimulation of almsgiving and at the control of beggars. A most remarkable record of an official promotion of begging comes from the region of Auvergne in France. In 1525, the consuls of Montferrand granted Robert Boudon a one-​year licence on behalf of ‘a great number’ of pouvres ladres who were inmates of the leprosarium of Herbet. Some of these were blind, ‘others are bedridden, so grievously ill that they cannot move from one place to another without the help and assistance of others, with the result that they are unable to go, either on foot or on horseback, more than two miles around this town to ask for the alms on which they live from day to day’.54 The consuls mandated Boudon to ‘make the collection [faire la queste] and, in the name of those poor, to request alms from the residents of towns and villages’. They gave him permission ‘to carry a clapper [cliquetes] together with the cup

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[baril, costrel], and to use these as if he were one of the said poor, in order better to draw devout people into giving alms’.55 The Montferrand officials forbade Boudon from ‘sitting or placing his cup in a place where the said ladres have the right to place theirs, for we do not intend to prejudice their rights’.56 This injunction matches the broader evidence that begging –​and, inferentially, soliciting with the clapper –​was a privilege that could be obtained and lost. The disposition of this privilege was a tool for curbing abuses of charity as well as for maintaining public order. As late as 1647, when a resident of the leprosarium near Elberfeld in the Lower Rhine region was found to be free of lepra, she was ordered not to use the clapper until a second examination might reconfirm her illness. The fellow leprosarium inmate who had reported her remission (and thereby deprived her of legitimate begging) ran into a charge of misconduct, including brawling, drunkenness and smoking. If he did not mend his ways, the judge warned, ‘the clapper would be taken away from him’.57 These anecdotes from the sixteenth and seventeenth centuries clearly show that the clapper could become a tool in public policy. Such direct evidence, however, is rare in archival records and, it seems, is entirely absent from iconography.58 The subjects in both anecdotes from Auvergne and the Lower Rhine were residents of a leprosarium, and the public role of the clapper is even less clearly documented when it comes to non-​ resident individuals. I  believe that there is a particular need for further clarification of Flemish references to akkerzieken, who seem to hold an ambiguous social position, somewhere between itinerant and sedentary, or between integrated and solitary. Historians commonly equate akkerzieken, as a group, with lèpres forains and Feltsiechen, since, after all, the Dutch word akker also means ‘field’. However, the root meaning of akker as a specific unit of area leads us to a different designation of zieken who were associated with ‘acreage’. This interpretation rests on admittedly limited premises from topography and art. A  medieval map of Bruges reveals the location, in the orbit of the Magdalen leprosarium, of four ‘pieces’ (sticks, or sticken, modern Dutch stukken) on which akkerzieken lived in ‘little houses’ (huusekens).59 They were presumably expected to live from cultivating their akker, but we may infer that their lives depended chiefly on alms.

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The indispensability of alms, in combination with the mention of the ‘little’ dwellings in Bruges, inevitably brings to mind a detail in a famous Netherlandish painting. In his Census at Bethlehem, Pieter Bruegel the Elder depicted a man holding a clapper in the doorway of a hut.60 An alms cup is prominently displayed in front of the hut, and a tiny backyard (akker?) is being cultivated by a person in customary leprosus garb. As is so often the case, the broader context adds special significance to this easily overlooked detail in a crowded tableau. Transposing an event in Roman Judaea (as reported in Luke 2:1–​5) to his own Spanish-​occupied Brabant, Bruegel replaced a census by the governor of Syria with a contemporary tax collection. This setting makes it possible that the hut dweller is shaking the clapper – ​with an air of stolid determination – ​not only to solicit succour but also to claim a tax exemption. Both objectives imply a public dimension, interaction between individual and community, and even official sanction. There are ample clues, which deserve exploration beyond the confines of this chapter, to the varying degrees of official involvement in the display of a clapper. The default assumption, that leprous beggars themselves took the initiative to procure and carry the implement, is not only difficult to verify but also far too general. Direct as well as indirect evidence (some of which we have seen in previous pages) suggests that it was common for local authorities or leprosarium regents to require and issue permits for begging and, more specifically, for holding a clapper. Inversely, authorities bypassed individual begging, at least to some extent, when they appointed an able-​bodied representative of the sick to carry a clapper, ‘proving their status, and signifying that he speaks for them’, as des Innocens reported for Toulouse; we saw Robert Boudon playing a similar role in Montferrand seventy years earlier.61 Authorities were also involved in communal initiative and group formation, most powerfully when they forced itinerant leprosi into confraternities, for which the clapper often became an emblem.

Confraternity emblem Links between organisations and clappers surface in iconography from the later Middle Ages and from the Low Countries more

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markedly than in any other era or area.62 This chronological and regional prominence coincides with the emergence of ‘lepers’ guilds’, which were indebted to one or more of the government influences –​ and on which much research remains to be done.63 Even for a facet as small as the role of the clapper, a few documentary references and representative illustrations may give an idea of the riches that await further exploration. At least four clappers are visible in a detail of the bustling Battle between Lent and Carnival, which Pieter Bruegel completed in 1559. The detail presents a procession by a dozen figures in brimmed hat and broad cape, the characteristic outfit of leprosi. The small scale and Bruegel’s idiosyncratic style make it difficult to determine whether, as it would appear, some of the facial features of these figures correspond to the facies leonina. Other features, however, clearly refer to an event staged by a ‘lepers’ guild’. Two members of the group are soliciting alms, while the others are proceeding behind a youth playing the bagpipe and a man bearing the ‘rattling tree’ (klaterboom or ratelboom). The tree is an unmistakeable clue to the celebration of ‘Crazy Monday’, the first Monday after the Feast of Three Kings (Epiphany, 6 January). This was a charity event, in which able-​bodied inmates and the staff of leprosaria participated by performing mummeries. Bruegel’s painting includes two of these mummeries, which suggests that the January ‘fundraiser’ was re-​enacted in the Carnival season.64 Celebrations of ‘Crazy’ or ‘Lost’ Monday, also known as ‘Copper Monday’, were analogous to the merrymaking of ‘Twelfth Night’, which, in a wider area, took place at around the same time in January. The Copper Monday revelry was most popular in the sixteenth century, in the region between Brabant and northern Holland. Several art works commemorate Koppertjesmaandag in Amsterdam, with the ‘Ommegang der Leprozen’ and people wielding clappers while collecting money from the bystanders.65 The combination of this activity with the prominence of the ‘rattling tree’ in each of these works –​as well as in Bruegel’s Battle –​ points to a background with important implications for our subject. The tree is decorated with a miniature scene in which puppets are dancing around a man who seems to be sawing wood. It is said to have been the standard of the sawyers’ guild.66 Scattered hints,

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still insufficiently examined, suggest that able-​bodied leprosi were allowed to practise carpentry. It is plausible that some of them may have formed a special confraternity or, inversely, that carpenters’ guilds took poor lepra sufferers as one of their charitable causes. In any event, the Copper Monday images reinforce the impression, conveyed by diverse other sources, that there were substantial overlaps, not only in the collection of alms but also in the display of clappers, between itinerant mendicants, confraternities, guilds and leprosaria. These overlaps constitute the background of a distinct section in iconography that comprises sculptured representations of Lazarus as patron saint of leprosi and their benefactors. All the extant sculptures are sixteenth-​century creations, and they are found only in modern Belgium, the Netherlands and Germany.67 Figure 8.22 shows one of two typical polychrome wood statues that have survived for almost five troubled centuries a few miles south of Antwerp. They are preserved in the historic town of Rumst where, in 1460, a leprous officer of the duke of Burgundy sponsored the building of a ‘lepers’ chapel’, which was rebuilt in 1590. By this time it had become the centre of a ‘village’ in which leprosi from across the duchy of Brabant congregated, mostly on official orders. From this community, ambulatory leprosi –​accompanied, possibly, by relatives and others  –​set out on their begging rounds with bowl and clapper. A confraternity was founded at Rumst in 1521. The statutes, confirmed in 1531 by Emperor Charles V, imposed a measure of discipline on the mendicants while also securing the interests of the residents and the disposition of alms, bequests and donations in general. The confraternities, in Rumst and elsewhere, promoted Saint Lazarus not merely as a patron of their members but also as a personification of their charitable mission. It is significant that physical signs of disease are lacking in the Rumst statues, and that such signs appear understated in similar sculptures (in so far as this can be determined from photographs). The absence of a halo in all these sculptures is also worth noting. Every one, on the other hand, typifies Lazarus or ‘the’ leprosus by the prescribed hat and cape and, most ostentatiously, by the bowl and clapper. This emphasis is equally clear in the relief on the Lazaruspoortje in Gouda, dated

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Figure 8.22  H[eilige] Lazerus. Polychrome wood statue, second quarter of the sixteenth century, Lazaruskapel, Rumst, Prov. Antwerp, Belgium.

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1609; on the front of a chest from the leprosarium of Diest, carved in 1627; and in the so-​called Kölner Leprosenmännchen from the Cologne Malaten leprosarium, sculpted in 1629. The most fascinating images of this genre are preserved in two objects that were created in Bruges a century apart. The older of the two Bruges artefacts is a banner that is inscribed with the date 1502 (‘MDII’) and is now out of sight in museum storage at the Louvre Museum in Paris.68 It shows signs of wear that, even if partly due to later neglect, suggest that it was more than an inert ornament: in other words, that it was not only displayed in a church or chapel but also carried in processions of patients, personnel and benefactors. The profusely illuminated banner is adorned with eight clappers as a motif in the margins. The centre features the Virgin Mary with the Christ child facing Saint Lazarus, who is portrayed along conventional lines, but with some interesting variants. The saint is haloed, carries a staff instead of a bowl, and has red blotches on his legs and bare feet. The key feature for our consideration, however, is the clapper, which he holds firmly, exactly in the optical centre of the entire banner. The principal scene is flanked by four vignettes, two on the left portraying Dives and pauper Lazarus, and two on the right staging the raising of Lazarus of Bethany. Kneeling at the bottom of the biblical illustrations are the donors of the banner, members of the prominent Gruuthuse family, who for at least three generations had been benefactors of the Bruges leprosarium. The banner was their gift to the Magdalen leprosarium or, in some way, to ‘the Friends of the Hospital’, as we would say today. A second artefact from Bruges also points to the overlap (and still unclear delineation) between hospital and charitable association. It is a carefully carved clapper from the early seventeenth century, with a relief of Lazarus that closely resembles the figure from Rumst in Figure 8.22.69 Lazarus holds a clapper upright, with the solemnity that by now has become a familiar feature. His formal gesture echoes the stylishness of the device on which he is depicted, which, as its pristine condition also indicates, was not intended for everyday begging but, rather, for ceremonial use in stationary or processional display. The presence of Saint Barbara on the reverse (or what we assume to be the reverse) side is somewhat puzzling, since she was venerated by various trades as well as for a good death, whereas Saint Mary Magdalen (sister of Lazarus), as patroness of

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leprosi (and sister of Lazarus) as well as of the Bruges hospital, would be a more obvious fit.70 Does this clapper, then, indicate that the leprosarium was now accepting non-​leprous patients at death’s door, or might it come from a trade guild that sponsored leprosi as one of its charitable causes? The ornamental clapper from Bruges presents a telling contrast with a group of counterparts from the contemporaneous northern Netherlands that were utterly unadorned and utilitarian, even though they, too, denoted formality. This group comprises items scattered among municipal museums from the Lakenhal in Leiden to the Catharina-​Gasthuis in Gouda, and it awaits comprehensive study. It is represented by two examples in Figure 8.23 that, like several other items in the group, have markings with critical and conclusive bearing on my thesis. On one side, most of the items show the coat of arms of Haarlem. The insignia attests to the town council’s endorsement of a privilege granted by the Landheer of Holland to the leprosarium outside the city walls.71 In 1413 Count Willem VI gave Saint Jacob’s Chapel the regional monopoly over the decisive ‘seeing [schouw]’ of people suspected of lepra,72 and to the issuing of a certificate (schouwbrief): either a schoonbrief for a ‘clean’ subject or a vuylbrief for an infected one. The ‘dirty letter’,

Figure 8.23  Two dated clappers, issued in Haarlem and now in the Enkhuizen Gemeentehuis Museum, the Netherlands.

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ironically, proved to be the more sought after. It provided such vital benefits as acceptance by the leprosarium, access to public assistance or, at least, permission to beg. This licence was underscored by the addition (perhaps not automatic) of the standard begging tool, which, in turn, gained force from the municipal coat of arms. Both marks on the other side of the Dutch clappers confirm municipal authorisation, but one is puzzling and the other persuasive. First, the engraved dates raise questions with far-​ reaching implications. The absence of multiples for the same year suggests a limited number of issues; it tempts speculation about a single licensed spokesperson; it even raises the possibility, albeit remote, of annual renewability. The dates extend from 1612 to 1794, which is more than a century beyond the last schouw in which someone was judged leprous. This chronology proves that proclaiming the bearer as ‘unclean’ was not the sole purpose of the clapper. On the other hand, compelling proof of a primary purpose lies in the abbreviation that surmounts the date. The capital letters ‘LP’, according to the most plausible interpretation and analogous occurrences, stand for ‘Lazarus Penning’. They identify the ‘pauper’s pence’ as the raison d’être of the clapper, the collection of alms as the specific objective and the display of the device as a privilege. Thus, these museum objects add considerable cogency to a revision of prevailing one-​sided notions about the clapper.

Conclusion A more precise assessment of the intended role of such artefacts as the Rumst sculptures, the Bruges banner and the Holland clappers will require a better understanding of the interaction between leprous or designated mendicants, leprosaria, confraternities and governments. Similarly, a more nuanced assessment of the changes in the clapper-​wielding figure, and particularly of the evolution from the prostrate pauper to the able-​bodied Saint Lazarus, awaits deeper insight into the correlation of lepra with disability and advocacy.73 Such studies would be separate enterprises with vast ramifications. Within our more circumscribed purview, it is fair to conclude that the figure of leprous Lazarus, whether as outcast or as spokesman, aimed at celebrating and stimulating generosity. If any of these

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presentations inspired fear, it was the fear of eternal punishment for selfishness, not the fear of a communicable disease. Along the same lines, leprosi were shown meeting Jesus or a saint as supplicants, not as menaces. The common themes were inclusion and attention, not exclusion and rejection. The thematic framework, buttressed by preserved artefacts, leaves no doubt about the primary significance of the clapper in iconography, as calling for compassion rather than threatening with danger. This certainty does not imply a stubborn negation of exclusionary dynamics, or a naïve assumption that the imagery mirrored the actual sentiment of the populace or the conduct of the powerful. The positive view should counterbalance, however, the one-​sided and dark nineteenth-​century imagination of medieval lepra in which fear and horror dominated.74 The iconography of lepra and leprosi suggests a transition from the frightening biblical cry of ‘unclean’ to a pressing plea for mercy. In this transition, the clapper became the voice of the poor leprous wretch, ‘vox miselli’.

Notes 1 Matthieu de Vendôme (Mattheus Vindocinensis), Historia Thobie cum moralitatibus ejusdam (Strassburg: F. Knolouch [sic], 1510), fo. 55v. 2 Misellus, which became mesel in English and meseau in French, was the origin of the modern term ‘measles’. On the other hand, the term morbilli was the medieval counterpart of measles. 3 L. Demaitre, Doctor Bernard de Gordon: Professor and Practitioner (Toronto: Pontifical Institute of Mediaeval Studies, 1980). 4 Demaitre, Leprosy. 5 Bernard de Gordon, Lilio de medicina (Seville: Meinardus Ungut and Stanislaus Polonus, 1495), p. x. In the early-​fifteenth-​century English version of the Lilium (in Oxford, Bodleian Library, MS Ashmole 1505, never printed), the phrase became ‘for a house of leprouse men and endless shame’. 6 For methodical and incisive critiques of these misconstructions, see Touati, Maladie, pp. 27–​58; and Rawcliffe, Leprosy. 7 C. M. Boeckl, Images of Leprosy:  Disease, Religion, and Politics in European Art (Kirksville, MO: Truman State University Press, 2011). 8 Rudolf Virchow, ‘A painting of lepers by Hans Holbein the Elder’, American Journal of Dermatopathology, 6(4) (1984), 377–​78. This

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article is ‘freely translated by S. M. Rabson, M.D. and J. H. Dirckx, M.D. from the original in the Archiv für pathologische Anatomie und Physiologie und für klinische Medicin, Berlin, 1861’. See Figure 8.3 in this chapter. 9 See W. B. Ober, ‘Can the leper change his spots? The iconography of leprosy’, American Journal of Dermatopathology, 5(1) (1983), 43–​58, and 5(2) (1983), 173–​86. 10 Mount Athos, Vatopedi Monastery, MS 602, fo. 108r. The most concentrated study of this manuscript is by John Lowden, who summarises his findings in ‘Illustrated Octateuch manuscripts:  A Byzantine phenomenon’, in P. Magdalino and R. Nelson (eds), The Old Testament in Byzantium (Washington, DC:  Dumbarton Oaks Research Library and Collection, 2010), pp. 110–​19. 11 ‘Martyre de saint Quentin’, in Livre d’images de Madame Marie, Paris, BnF, MS NAF 16251, fo. 82v. It is reasonable to argue that the spots on Saint Quentinus differ from the ones that, in the same manuscript (fo. 103v), mark a leprosus who is holding a clapper while having his feet washed by Saint Elisabeth. 12 ‘Laurentius’ before Emperor ‘Decius’, fresco in the Sancta Sanctorum Chapel, Lateran Palace, Rome. 13 https://​imagesonline.bl.uk for shelfmark ‘Royal 6 E.  VI, f.301’, # 062047 (accessed 20 September 2012). The caption was eventually corrected to ‘Clerics with leprosy receiving instruction from a bishop’, www.bl.uk/​catalogues/​illuminatedmanuscripts/​ILLUMIN. ASP?Size=mid&IllID=32116 (accessed 2 May 2016). For an exhaustive analysis of this unique manuscript, see L. Freeman Century Encyclopedia of Sandler, Omne bonum:  A Fourteenth-​ Universal Knowledge, 2 vols (London: H. Miller, 1996). 14 http://​bldeathnet.hypotheses.org/​213 (accessed 26 July 2019). 15 Virchow, ‘A painting of lepers’, p. 378. The painting is also reproduced and discussed in Boeckl, Images of Leprosy, pp. 124–​9. 16 The municipal accounts of Bruges, for example, recorded the pairs of gloves that were handed to persons who were suspected of having lepra, from 1305 to 1580:  G. Maréchal, ‘Lepra-​onderzoek in Vlaamderen (XIVde–​XVIde eeuw)’, Annalen van de Belgische Vereniging voor Hospitaal-​Geschiedenis, 14 (1976), 27–​ 65 (pp. 44–​ 5). Miniature of Christ healing a leprosus in the Holkham Bible, Anglo-​Norman, south-​east England (London?), c. 1327–​35. London, BL, Additional MS 47682, fo. 23. 17 One noteworthy common element in these images is that, with very few exceptions, they present ‘distinctive clothing as a form of identification

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rather than an inalienable marker of disease’, as L. Barnhouse observes in Chapter 7 in this volume (pp. 183–​207). 18 Reproduction and comment in Boeckl, Images of Leprosy, pp. 85–​7. Another instance for the Continent, mentioned by A. M. Peterson in Chapter 11 in this volume (pp. 323–​43), was the use of bells in Siena as ‘markers of sanctioned begging’. 19 The most famous example is an illumination from an early-​fifteenth-​ century English Pontifical in London, BL, MS Lansdowne 451, fo. 127. It is reproduced (black and white) and captioned in Rawcliffe, Leprosy, p. 199; also (in colour) on the cover of P. Richards, The Medieval Leper and His Northern Heirs (Cambridge: D. S. Brewer, 1977). 20 While an arguably obscure painter, Cooper stands out for his depictions of cancer (1910), diphtheria (1910), syphilis (1912), tuberculosis (1912) and typhoid (1912); today, his most prominent representation is on the site https://​moviesandmania.com/​2014/​02/​19/​ richard-​tennant-​cooper-​artist/​ (accessed 26 July 2019). 21 London, Wellcome Collection, image no. L0058454 (showing reproduction clappers now held at the Science Museum, London), with the caption ‘a copy of an original from the 1600s, which came from St Nicholas leper hospital in Kent, England. Henry Wellcome did his utmost to acquire objects for his collection. He was not always successful. Undeterred, he would seek permission to have copies made of those objects he could not acquire.’ https://​wellcomecollection.org/​ works/​j5xf2wr5 (accessed 26 July 2019). 22 In England, and for various reasons, the fourteenth century also saw a ‘dramatic decline in the number of functioning leprosaria’ according to C. Rawcliffe in Chapter 4 in this volume (pp. 108). 23 The most notable three-​ dimensional precedents illustrated the encounter between Christ and a leprosus. One is an early-​ninth-​century ivory carving in the Andrews Diptych, Victoria and Albert Museum, London (discussed by F-O. Touati in Chapter 2 in this volume (pp. 48–​ 9)). Another is a ninth-​century gold repoussé on the cover of the Codex Aureus of Saint Emmeram, Munich, Bayerische Staatsbibliothek, CLM 14000. 24 While it is not clear when exactly the fusion took place between the leprosus and the pauper Lazarus –​and, further, Lazarus of Bethany, who was raised from the dead by Jesus –​it is useful to note that the term lazari was derived from Saint Lazarus. The label, introduced in Greek by Gregory of Nyssa (d. 394), entered Latin in the ninth century, as Touati observes in Chapter 2 in this volume. 25 Incentives for comparative study range widely in this volume, from a general plea for a ‘holistic approach’ (Roberts, Chapter 1, pp. 23)

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to a reassessment of the connections between East and West (Touati), and from contextualisations of regional responses in northern France (E. Brenner, Chapter 6 (pp. 161–​179)) and in the Rhineland (Barnhouse) to a systematic comparison of Narbonne and Siena (Peterson). 26 Another illumination by the same artist, Jean Poyer, presents Lazarus in the doorway, shaking the clapper with one hand and holding the costrel, or beggar’s cup, with the other:  The Hours of Henry VIII, New  York, Morgan Library, MS H.8, fo. 134v. A  contemporary manuscript painting by François Maître has Lazarus waving a clapper while declaring (in a text balloon), ‘I beg for the crumbs that fall under the table of the rich man’: in Raoul de Presle’s translation of Augustine’s City of God, The Hague, Koninklijke Bibliotheek, MS MMW 10 A 11, fo. 16v. A  much earlier historiated initial should settle doubts, as it shows Lazarus pointing to the clapper while raising it:  initial ‘D’ in a choir book for the use of Fontevrault Abbey, c. 1250–​60, Limoges, Bibliothèque municipale, MS 0002, fo. 214. 27 For the context of this iconography, see M. Jeanneret, A Feast of Words: Banquets and Table Talk in the Renaissance, trans. J. Whiteley and E. Hughes (Chicago: University of Chicago Press, 1991). 28 In other lepra iconography, leprous women appear mainly as suffering saints (including Aleidis, Angadrisma and Enimie), who, by virtue of their sacrifice and self-​denial, would not have used a clapper for drawing attention to themselves. Women (including Elisabeth, Cunegundis and Radegund) appear most prominently among the saints who ministered to leprosi. 29 In 2015, women accounted for 38.8 per cent of new cases of Hansen’s disease, as Roberts points out in Chapter  1 in this volume (p. 23). Averages stayed below 30 per cent in my various tabulations of 530 recorded diagnoses from western Europe between 1300 and 1600. L. Demaitre, ‘Official objectives of the Visitatio leprosorum: Ambiguity, ambivalence, and variance’, in C. Rawcliffe and C. Weeda (eds), Policing the Urban Environment in Premodern Europe (Amsterdam: Amsterdam University Press, 2019), pp. 303–​50. 30 A selection of ten remarkable portrayals of the single leprous supplicant gives an idea of the potential for further comparative study, with relation to the meaning of the clapper as well as various other aspects. (1) a miniature in Guillaume de Digulleville, Pèlerinage de Jésus Christ, Paris, c. 1400 (Paris, Bibliothèque de l’Institut de France, MS 9, fo. 39v; (2)  a leprosus with gloves and covered mouth, kneeling before Christ as Man of Sorrows, miniature in a cartulary of the Saint Sebald leprosarium Nuremberg, 1450 (Nuremberg, Stadtarchiv, A 21 Nr. 32.4° II); (3) a miniature

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in the Vorauer Volksbibel, 1467 (Vorau, Stiftsbibliothek, Codex 273); (4)  a historiated initial ‘A’ in the missal of Eberhard von Greiffenklau, second quarter of the fifteenth century (Baltimore, MD, Walters Art Museum, MS W.174, fo. 22v); (5)  a manuscript drawing in Giovanni da Udine, Compilatio historiarum, Basel, c. 1476 (New  York, Morgan Library, MS M.158, fo. 31v); (6)  an emotionally wrought engraving by Georg Pencz in the series of 35 (Amsterdam, etchings Das Leben Christi, Nuremberg, 1534–​ Rijksmuseum); (7) a woodcut in the Latin translation by Rudolphus Gualtherus of Desiderius Erasmus, Noui testamenti aeditio postrem, Zurich, 1547, fo. 9v; (8) an etching by Virgil Solis, who portrayed the leprosus with a covered mouth, fugitive sheet, c. 1550, Herzog Anton Ulrich-​ Museum, VSolis WB 3.50; (9)  a woodcut in Jean Benoit, Testamenti novi editio vulgata (Lyon: apud Ant. Gryphium, 1570), in which Christ lays a hand on the head of the leprosus; (10) a woodcut after Joost Amman, in Icones novi testamenti (Frankfurt am Main, 1571), in which the supplicant is shown kneeling, with a clapper hanging from his belt, and with covered mouth. 31 Impressive examples include diverse woodcuts in editions in Wittenberg, 1544; Wittenberg, 1549; and Nuremberg, 1670; and, even later, an engraving from Nuremberg, 1702. 32 One remarkable and, as yet, puzzling instance of the overlap is the portrayal of a leprous man among pilgrims and sick supplicants in the painting reproduced in Figure 8.18. 33 Discrete aspects of this variety appear throughout Part IV of this volume, including encounters (Chapter  9), pilgrimage (Chapter  10) and vagrancy (Chapter 11). The issue of estrangement is addressed in Chapter 3. 34 Several woodcuts emphatically project the authority of Christ over the leprosi. One, by Johann Eck, was published in Augsburg in 1532; another, considerably later, in Evangelia und Episteln (Magdeburg, 1723). 35 Another exception is a woodcut of 1521–​22 by Lucas Cranach, who portrayed the leprosi as part of a group of indigents. Amsterdam, Netherlands, Rijksmuseum, RP-​P-​OB-​4455(R). 36 The only other regional ‘Iberian’ exception that I have found until now, and which is arguably even more intriguing, is a folksy polychrome statue of Lazarus from the third quarter of the sixteenth century in the Canary Islands:  J. G.  Rodríguez Escudero, ‘San Lázaro, una imagen del siglo xvi del patron de los leprosos en Santa Cruz de la Palma’, in Ileus, Portal de humanidades, available at www.liceus.com/​cgi-​bin/​ ac/​pu/​escudero/​San_​Lazaro_​leprosos.asp (accessed 3 May 2016). This

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Lazarus, with full beard and unblemished face, is holding a clapper and a bowl. 37 One intriguing later neo-​ classical engraving portrays a nimbused ‘Heilige Lazarus’ wielding a clapper; he appears youthful and unblemished, though with arguably disproportionate arms and hands. The engraving was originally described as ‘after plate by Marcantonio Raimondi (1480–​ 1527), Italy, 1500–​ 1575’, www.rijksmuseum.nl/​ collectie/​zoeken/​asset.jsp?id=RP-​P-​OB-​11.873000000 (accessed 20 November 2012). I  have not been able to find an original by Raimondi (whose major fame lies far from the realm of hagiography). In a subsequent catalogue entry, as Object Nr RP-​P-​OB-​11.873, the engraving is captioned as anonymous. www.rijksmuseum.nl/​en/​search/​ objects?q=lazarus&p=1&ps=12&maker=Marcantonio+Raimondi& technique=engraving&title=lazarus&yearfrom=1500&yearto=1575 &ii=0#/​RP-​P-​OB-​11.873,0 (accessed 3 May 2016). 38 In Chapter  9 in this volume C. A. Krolikoski demonstrates the importance of chronology for the way in which the interactions between Saint Francis and the leprous poor were portrayed. 39 Demaitre, Leprosy, pp.  47, 65, 111, and 200–​1. On the 1250 leprosy examination in Siena, see Peterson, Chapter 11 in this volume, pp. 331–2. 40 It is instructive to compare the Pescia painting with a fifteenth-​century Tuscan miniature in which Saint Francis, together with three of his brethren in a hospital, is ministering to five patients who are expressly identified as leprosi in the accompanying text, and by the clappers that two in the foreground are shaking. However, the sizeable pustules that cover the half-​naked patients are not readily indicative of leprosy, and they have been interpreted variously as smallpox, plague and the ‘French disease’ (syphilis). An adequate analysis of this scene requires more attention than it can receive here. The miniature is in Giacomo Oddi da Perugia, La franceschina, Perugia, Biblioteca comunale Augusta, MS 1238, fo. 223r. http://​augusta.alchimedia.com/​indice_​ documento.aspx?prov=div&ID=122&cod=Ms_ ​ 1 238&page=428 (accessed 23 November 2012). Also www.gettyimages.com/​license/​ 500637751 (accessed 4 May 2016). 41 No image of Saint Martin seems to have been imitated, reproduced and captioned more often than the panel by the ‘Meister von Sierentz’ in the Basel Kunstmuseum, in which the beggar is marked by generic and equivocal tuberosities. An exception to this indistinctness may be an altarpiece in Sankt Florian monastery, Austria, which depicts the beggar at the feet of Saint Martin  –​not on horseback here, which is an iconographic oddity for this episode as usually depicted –​with arguably more typical signs of leprosy.

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42 Touati provides historical context for Saint Martin in Chapter 2 of this volume. The encounter is the subject of an enlightening chapter by C. Peyroux, ‘The leper’s kiss’, in S. Farmer and B. H. Rosenwein (eds), Monks and Nuns, Saints and Outcasts: Religion in Medieval Society (Ithaca, NY: Cornell University Press, 2000), pp. 172–​88. The cover of the book in which Peyroux’s chapter appears presents the same drawing as our figure. Peyroux, it may be noted, is still beholden to earlier exaggeratedly negative assessments in general and, in particular, to the view that ‘clappers and bells [were] used to warn the healthy of the leper’s approach’ (p. 175). 43 The three figures in the background (apparently led by Saint Brice, Martin’s deacon and controversial successor as bishop) seem to participate in the encounter and, in addition, to tell a separate story. However, they do not appear in the contextual narrative of Sulpicius Severus, which I  have consulted in the most convenient, if not the most up-​to-​date, edition, De vita beati Martini, cap. XXIII [sic, read XVIII], ed. J. Leclerc, in Sulpicii Severi quae exstant opera omnia (Leipzig: Thomas Fritsch, 1709), Vol. I, pp. 334–​5. 44 M. Barber, ‘Lepers, Jews and Moslems:  The plot to overthrow Christendom in 1321’, History, 66 (1981), 1–​17. 45 This other painting illuminates the chapter ‘De la condempnacion des meseaux’, in Chroniques de France ou de St Denis, London, BL, Royal MS 20 C VII, fo. 56v. It shows the meseaux, engulfed by the flames, semi-​naked, with spots on their torsos, with hands tied to the stakes, and without clappers; the executioners cover their faces while stoking the fire; court officials converse while witnessing www.bl.uk/​catalogues/​illuminatedmanuscripts/​ the proceedings. ILLUMIN.ASP?Size=mid&IllID=41773 (accessed 4 May 2016). 46 The first three items were also emblematic of pilgrims, and even of travellers in general. 47 The statutes are preserved in two closely similar manuscripts (‘manuscrits jumeaux’) in the Cathedral Archives of Tournai:  Bibliothèque de la Ville, MS 24; and Fonds des hôpitaux, IV, 1/​01. A  modern French translation by the archivist Jacques Pycke was published in L’Hôpital Notre-​Dame à la Rose:  Près de huit siècles d’histoire européenne d’assistance spirituelle et de soins médicaux au Coeur de Lessines (Tournai:  Wapica, 2015). I  have not yet seen this publication, but I am profoundly grateful to Professor Pycke, who generously provided me not only with the pertinent text and full information, but even with a copy of the miniature and permission to publish it (personal correspondence, April–​May 2016).

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48 In order to maintain a thematic focus, I largely forgo discussing images in which the clapper did not primarily denote a status of indigence or supplication but, rather, identified lepra per se, specifically and sometimes even in the absence of bodily signs. In addition to the images cited in nn. 30 and 31, suffice it to mention the remarkable miniature illuminating the chapter ‘de lepre et de mesellerie’ in a fifteenth-​century manuscript of the French translation of Bartholomaeus Anglicus, De proprietatibus rerum, Paris, BnF, MS Fr. 22532, fo. 118. 49 Arndorfer Altar, Maria Saal, Carinthia, Austria. Efforts to obtain a colour reproduction directly from the site have thus far been unsuccessful. A small black-​and-​white photograph of the entire back of the polyptych is included (p. 86) in the Diplomarbeit, or master’s thesis, of Doris Rosmarie Hassler, ‘Die gotische Ausstattung der Propsteipfarrkirche Maria Saal’ (University of Vienna, 2011). I  was able to read the thesis thanks to the kind assistance of Christine Boeckl and Brigitte Boeckl, who were also instrumental in helping me to place this image in its broader context. 50 For more on these bands, see Demaitre, ‘Official objectives’, p.  330. A  nineteenth-​century historian suggested a far-​fetched yet intriguing etymological connection between itinerant groups and the clapper: ‘Les lépreux ne pouvant sortir sans une clique ou cliquette et faisant bande à part, furent désignés sous le nom de clique’; A. Baron De Coston, Origines étymologiques et signification des noms propres et des armoiries (Paris: A. Aubry, 1867), p. 92. 51 Guillaume des Innocens, Examen des éléphantiques ou lépreux, recueilly de plusieurs bons et renommez Autheurs … (Lyon: Thomas Soubron, 1595), p. 18. 52 Modes, notions and fears of transmission almost constitute a subtheme in this volume, as they are considered in nearly every chapter. 53 Des Innocens, Examen des éléphantiques, p. 19. 54 Act of 3 June 1525 by the consuls of Montferrand, transcribed in the doctoral dissertation of Johan Picot, ‘Malades ou criminels? Les lépreux devant le tribunal de la Purge de Montferrand à la fin du Moyen Age’ (defended at Université Jean Moulin, Lyon 3, on 26 June 2012), 3 vols, Vol. II, p. 198. I am very grateful to Dr Picot for sharing his scholarly and monumental study, which, one hopes, will be published soon because it sheds light on a wide range of historical issues. Meanwhile, an informative précis is J. Picot, ‘ “La Purge”: Une expertise juridico-​médicale de la lèpre en Auvergne au Moyen Age’, Revue historique, 662 (2012), 292–​321. 55 Original French text in Picot, ‘Malades ou criminels?’, Vol. II, p. 199. 56 Ibid., Vol. II, p. 199.

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57 O. Schell, ‘Zur Geschichte des Aussatzes am Niederrhein’, Sudhoffs Archiv für die Geschichte der Medizin, 3 (1910), 343–​4. 58 One instance of direct evidence may be found in an edict issued in The Hague in 1586 by Prince Maurice of Orange and the Estates General of the United Netherlands. The edict, intended primarily against beggars who falsely pretended to be leprous, included ‘een Klappe inde hant’ among the marks by which certified leprozen should identify themselves. Text in M. Tóth-​Ubbens, Verloren beelden van miserabele bedelaars:  Leprozen  –​ Armen  –​ Geuzen (Lochem:  De Tijdstroom, 1987), Annex II, pp. 98–​9. The monograph is supplemented by a summary in English by P. Wardle, pp. 100–​6. 59 R. A. C. Pannier, Van gissen naar weten (Bruges: Van der Wiele, 2008), p. 302. 60 In the right-​hand quarter of Pieter Bruegel the Elder, The Census at Bethlehem, 1566. Brussels, Royal Museums of Fine Arts of Belgium, Inv. 3637. Unfortunately, it has proved impossible to reproduce the detail in black and white with sufficient visibility of the clapper. 61 Des Innocens, Examen des éléphantiques, p. 18. For Boudon in 1525, see n.  55 above. It is possible that Lazarus statues, including that shown in Figure 8.22, represented this kind of ‘spokesperson’. 62 A pertinent and remarkable 1493 broadsheet from Nuremberg is reproduced in Demaitre, Leprosy, p.  48 (Plate 2, with discussion at pp. 45–​51). 63 A major challenge is the general scarcity of written records for non-​hospital associations, as Barnhouse notes for the Rhineland in Chapter 7 of this volume. 64 Kunsthistorisches Museum, Vienna. Detail near the centre in the upper quarter of the painting. Here, as was the case for the earlier mentioned Census at Bethlehem, it proved impossible to reproduce the details for useful black-​ and-​ white print. I  have found the most complete reproduction and the most informed description of these scenes in Tóth-​Ubbens, Verloren beelden, p. 80 and the plates inserted between pp. 64 and 65. 65 The most illustrative of these portrays ‘the little sick’ (De Sieckgens) on what might now be called a ‘benefit drive’. It is an etching, executed by Claes Jansz Visscher the Younger in 1608. The old leprosarium on the Saint Antoniesdijk is shown in the background. http://​archief. amsterdam/​archief/​10094, image 010094007055 (accessed 6 May 2016). Different in style and content, and with wider scope, is a painting of 1633 by Adriaen van Nieulandt that was commissioned by the governors of the leprosarium located on the present Visserplein. http://​archief.amsterdam/​archief/​10097, image 010097007279

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(accessed 6 May 2016). As late as 1729, a depiction of the Processie der Lazarussen op Kopper-​Maandag shows a woman ostentatiously shaking a clapper while collecting alms. http://​archief.amsterdam/​ archief/​10097, image 010097007278 (accessed 6 May 2016). 66 These speculations call for caution and further research. Some captions in the Amsterdam archives, for example, hint at the possibility that the central figure in the scene may be a printer rather than a sawyer. 67 The most puzzling exception is the sixteenth-​century statuette of San Lázaro in Santa Cruz de la Palma on the Canary Islands, cited in n. 36 above. 68 Now in Paris, musée du Louvre, INV20224. www.photo.rmn.fr/​ archive/​73-​001438-​2C6NU0HBPTJ2.html (accessed 9 May 2016). Comments on the banner in Pannier, Van gissen naar weten, pp. 307–​9, with a high-​quality colour reproduction as a valuable insert. 69 The clapper is now at the Onze-​Lieve-​Vrouw-​ter-​Potterie Hospitaal Museum in Bruges. Both sides are reproduced in Demaitre, Leprosy, p.  56 (Plate 3, with commentary on pp.  57–​ 8). For a thorough examination, see J.  L. De Meulemeester, ‘De melaatsenklepper in het Museum van O.-​L.-​Vrouw-​ter-​Potterie te Brugge’, Antiek, 22 (1988),  393–​9. 70 An illumination in a Bruges manuscript of 1454 portraying Saint Mary Magdalen between the sisters and (tonsured) brothers of the leprosarium, with the caption ‘O patrona pia’, is reproduced in W. de Keyzer, M. Forrier, M. van der Eycken et al., Lepra in de Nederlanden (12de–​18de eeuw) (Brussels:  Algemeen Rijksarchief, 1989), Plate 34. 71 C. De Koning, Tafereel der Stad Haarlem, Vol. I (Haarlem: A. Loosjes, 1807), pp. 72–​5 (p. 75). 72 On leprosy examinations in the Rhineland, see Barnhouse, Chapter 7 in this volume. 73 For a solid foundation for such insight, see I. Metzler, Disability in Medieval Europe:  Thinking about Physical Impairment in the High Middle Ages, c. 1100–​c. 1400 (London: Routledge, 2006). 74 See K. Vongsathorn and M. Vollset, Chapter 12 in this volume.

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Part IV

Religious and social identities

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9 Kissing lepers: Saint Francis and the treatment of lepers in the central Middle Ages Courtney A. Krolikoski The Lord gave me, Brother Francis, thus to begin doing penance in this way:  for when I  was in sin, it seemed too bitter for me to see lepers. And the Lord Himself led me among them and I showed mercy to them. And when I left them, what had seemed bitter to me was turned into sweetness of soul and body. Saint Francis of Assisi, The Testament1

Leprosy has long been regarded as the disease of the Middle Ages. The identity of ‘the medieval leper’ has largely been discussed in the historiography of leprosy in order to understand better the place and function of people with leprosy in medieval society. However, as the papers presented in this volume show, contemporary responses to the disease were many and varied.2 Depicted and dispersed through a variety of mediums, including medical and religious treatises as well as works of art and written legends, the history of leprosy and societal responses to the disease have endured in a complex, contradictory and often horrifying narrative. While leprosy was often associated with the stigma of sin and subject to negative social responses, in the twelfth and thirteenth centuries persons with leprosy also held a special religious status that linked them directly to Christ and the saints. It was this connection to the divine that made them an ideal beneficiary of charity and popular devotion.3 This was, however, understood to be a reciprocal contract. Donations to assist the poor and the sick were believed to be repaid through the prayers of the recipients –​and the prayers of lepers were considered to be particularly effective in ensuring the

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salvation of their donors.4 Despite this, the image of the excluded, stigmatised leper has endured. As one of the key ruling authorities of the central Middle Ages, the Church used this dual status of the leper to suit its contemporary needs. What resulted were two distinct but conflicting understandings and perceptions of the nature of leprosy. Before the twelfth century, leprosy was often portrayed as divine punishment imposed upon the morally ill. However, during the twelfth century and increasingly in the thirteenth century, leprosy came to be depicted as a disease of the pauperes Christi, the so-​called ‘poor of Christ’. Lepers, according to this view, suffered on earth with the disease so that they could enjoy the next life without suffering in purgatory.5 Although both perceptions of the disease have co-​existed throughout its history, a shift undoubtedly occurred in the twelfth and thirteenth centuries. This shift, from viewing leprosy as an illness of a person’s character to seeing it as an illness miraculously granted by God, was central to popular perceptions of leprosy at this time. This chapter will consider one of the decisive factors in this shift:  namely, the influence of charismatic religious figures, or saints. The impact of the saints has been largely neglected in the study of social perceptions of leprosy. As the focus of great religious devotion, saints played a powerful role in the medieval world, promoted through the widespread dissemination of hagiographic materials. In this chapter I will examine the change in how people with leprosy were viewed in the thirteenth century, with specific attention to the role of one widely known and influential saint, Francis of Assisi. Through a close reading of a number of Francis’s hagiographies, and by situating these sources in their historical context, I  present a comprehensive study of one man’s influence over social perceptions of what was, and in many ways remains, a highly stigmatised disease. Although the evolution of Franciscan hagiography during the thirteenth century was partially a response to and reflection of rising controversies within the Franciscan Order, these texts’ impact on medieval society was pivotal. At a moment when the Church was experiencing a mounting spiritual crisis, Francis stepped up and embraced a leper. This one action, in many ways, redefined both the idea of sanctity and the understanding of leprosy in the central Middle Ages. The discussion that follows will consider the

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legacy of the interactions between Saint Francis of Assisi and lepers, and how Francis’s actions helped to bridge the gap between society and a group that was both marginalised and revered.

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Saints and lepers: pre-​Franciscan instances While the saints before Francis who ministered to lepers were few in number, their hagiographies provide the basic framework for the depiction of a saint crossing a well-​defined social boundary physically to embrace the leprous poor. The two most influential saints to embrace lepers in the early Middle Ages were Saint Martin of Tours and Saint Radegund. It is through their hagiographies that the literary tradition of saints showing compassion toward the leprous, just as Christ had, began.6 Saint Francis and his mode of life may have represented a new and influential form of spirituality in the thirteenth century, but that spirituality relied heavily on the tradition of Francis’s predecessors. In the central Middle Ages people believed that sainthood was bestowed upon those who lived an exemplary life, which is to say, a life in imitatio Christi. While living in this manner was also considered a mark of supreme piety in the late antique Christian world,7 its practice declined in the early Middle Ages in favour of other paths towards sanctity. Living in imitatio Christi would only be revived as a mark of sanctity after the turn of the eleventh century in reaction to an evolving spiritual crisis within the Church.8 With a return in the Church to the traditions and ideals of the early saints, Francis’s own hagiography would ultimately develop in imitation of saints such as Martin and Radegund. Saint Martin of Tours (d. 397) is seen as the first saint truly to live his life in imitatio Christi.9 He is also the first recorded saint to have physically crossed the boundary between the clean and the unclean by kissing a leper. In this well-​known event within his vita, Martin was standing near the gates of Paris surrounded by a large crowd when a leper approached him and grabbed onto his clothing. Without hesitation, and with all eyes on him, Martin kissed the leper.10 Despite the horrified reaction of the crowd, Martin blessed the leper and ‘[the leper] was instantly cleansed from all his misery’.11 The kiss was not only revolutionary

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because Martin physically crossed the well-​ defined boundary between medieval society and the leprous, but also because his actions healed the leper of his malady. Catherine Peyroux notes that though this episode was short and straightforward, the description of the reaction of the crowd to the kiss highlights the power, and longevity, of the miracle.12 Saint Martin created a new and enduring association of sanctity with leprosy that would eventually impact Saint Francis.13 Martin’s interaction with a leper was not an isolated incident in the early Middle Ages.14 In the sixth century, the Frankish princess Saint Radegund (d. 587)  would go further than Martin in transgressing the social boundary associated with the leprous. One day, when a group of lepers arrived at her cloister in Poitiers, Radegund embraced, kissed and gave alms to each of them. Unlike Martin, Radegund’s kiss did not have the power to heal the lepers of their disease. Instead her kiss was the physical demonstration of her supreme humility and devotion to providing charity to the poor.15 This sentiment was highlighted the most profoundly after the lepers had left Radegund’s cloister. One of her attendants, horrified by her actions, asked, ‘Most holy lady, when you have embraced lepers, who will kiss you?’16 Replying to this, Radegund simply stated, ‘Really, if you won’t kiss me, it’s no concern of mine.’17 While Saint Martin and Saint Radegund are the two most notable saints of the early Middle Ages to have interacted with the leprous poor, they are by no means the only ones. Saint Amatus (d. 418), Saint Romanus of Condat (d. 463), Saint Fursey (d. 650) and Saint Frideswide (d. 735) are a few other saints known to have episodes in their hagiographies wherein they provided care to lepers. These vitae helped to define and shape the literary tradition that the hagiography of Francis would join in the thirteenth century. Such early instances of saintly men and women ministering to the leprous supplied the model for later saints to truly live in imitatio Christi, as well as proving a framework for the composition of later vitae. However, for Saint Francis of Assisi, interaction with the leprous would not only be used to highlight his humility and sanctity, it would also become a vital aspect of his ensuing legacy. Francis’s interactions with the leprous poor would become the pivotal element of his personal conversion from a secular life to one lived in the footsteps of Christ.

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The Franciscans: rise and controversy While Saint Francis was not the first religious figure to interact with lepers, his interactions with them were still revolutionary. Francis’s rise to prominence in the late twelfth century occurred at a moment when the medieval world was undergoing drastic changes.18 It was embarking on a phase of extensive expansion  –​both demographic and economic –​that would not slow down until the mid-​fourteenth century.19 When this expansion combined with a lay population that was becoming increasingly literate, religious dissent began to spread.20 Instead of relying on the Church for spiritual guidance, members of lay society began exploring alternatives for ensuring their salvation. Literate members of lay society, through careful study of the New Testament,21 developed radical interpretations of how to live their lives in accordance with God’s word and, as a result, groups began to form around charismatic figures. It was into this setting of growing spiritual crisis and change that Francis was born, and out of it that the Franciscan Order developed. Francis’s Order represented a new form of spirituality that the western world had not previously seen, one that was in contrast to the prominent religious and social practices of the times. The ideals of the Order arose out of Francis’s commitment to living according to the Gospels, through adopting a life that was a collective form of the vita apostolica. However, as the Order became larger and spread further from its roots in Italy, it began to struggle with internal administration, regulation and focus. Even within his own lifetime Francis saw the Order dividing into two distinctive factions.22 The most heated debates revolved particularly around the issue of poverty. One side of this debate was a conservative group, the Spirituals,23 who protested the Order’s increasing movement away from the original ideals that Francis promoted. They wanted to preserve and, perhaps, in a sense, revive the devotion to the simplicity and poverty of their beginnings.24 The other faction in this split was the Conventuals, a moderate group who embraced the changing landscape of the thirteenth century in western Europe. They placed less emphasis on poverty in order to make membership of the Order more accessible to new and younger friars by allowing them to maintain some secular comforts.25

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This internal schism in the Franciscan Order manifested itself most clearly through the biographical writings on the saint. As Francis’s visibility and importance grew, his public image became carefully used and manipulated by both the Spirituals and the Conventuals. Through these manipulations, both sides attempted to present an image of Francis that aligned with their beliefs and priorities for the future of the Order. Within this context, the leper became an important figure to be used and manipulated to help present the desired image of Francis.

Saint Francis of Assisi: the role of the lepers in his conversion Born in Assisi in either 1181 or 1182, Saint Francis26 was the first example of a new type of holiness that acted contrary to the rising control of the Church in secular life, but was nonetheless completely rooted in the biblical tradition.27 Jacques Le Goff explains that Francis’s sanctity manifested itself not through virtues and miracles, but instead through his living a completely holy lifestyle that could serve as an example for others.28 ‘Francis was no self-​ effacing saint’,29 explains Rosalind Brooke; in his desire to imitate the life of Christ and His Apostles, Francis focused on a literal interpretation of the Gospel. Francis’s first biographer, Thomas of Celano, explains in the Vita prima that in his youth Francis ‘passed his time from childhood and miserably wasted and squandered his time … Maliciously advancing beyond all of his peers in vanities, he proved himself a more excessive inviter of evil and a zealous imitator of foolishness.’30 Francis’s early years were spent in a cycle of lusting after personal glory and engaging in spiritual questioning. Unlike the common practice in most hagiography, where a saint has an instant transformation based on a single moment of illumination, Francis’s conversion was long and confused.31 Early chapters of his vitae show progression towards conversion; however, despite knowing that he wanted to become a man of God, Francis did not know how to proceed.32 After a long struggle to escape his ties to the secular world, Francis finally shed the clothing that had once marked his place in society and traded the comforts of his family’s home for the harshness of poverty. However, it seemed as though every time he

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removed himself further from society it was somehow still not far enough. According to Thomas of Celano in the Vita secunda, it was at this point that God showed him that he still had obstacles to overcome: ‘If you want to come to know Me, despise yourself. For when the order is reversed, the things I say will taste sweet to you even though they seem the opposite.’33 Many early episodes within his life can be, and have been, considered by scholars to be the main catalyst for Francis’s conversion. However, according to Le Goff, many of these first events of his conversion to a spiritual life actually amounted to ‘false steps’.34 This chapter will argue that the defining element of Francis’s conversion came later, at the hands of society’s most repulsive ­figure –​the leper. To be finally completely separated from the secular world, Francis would have to cross the social boundary and learn to love these complex figures. Francis had a ‘natural horror of lepers’,35 as did many of his contemporaries.36 In his youth, his disgust for lepers was so great that ‘when he saw their houses even two miles away, he would cover his nose with his hands’.37 It is this aversion that would become the cornerstone of Francis’s conversion as well as his ensuing ministry. By overcoming his repulsion and embracing the ‘bitterness’ of the lepers, he finally severed his ties with the secular world and would be able to enjoy the ‘sweetness’ of knowing God. What is most interesting about this ultimate moment of conversion for Francis is how it evolves with each vita over the course of the thirteenth century. All versions of this story agree on one point: Francis met a leper on the plains below Assisi and, following divine inspiration, kissed him.38 This is one of the main episodes within Francis’s life, which was manipulated with each version of the saint’s biography. In earlier versions of the vita the leper is regarded only as a tool through whom Francis overcomes his tendencies. However, in subsequent versions the leper becomes a guise used by Christ to test Francis’s devotion. These changes in the vitae were used to present an image of Francis that was most aligned with the aims of either side of the schism within the Franciscan Order. Before pursuing this argument, it is important here to note the significance of the kiss in the Middle Ages.39 The kiss has numerous biblical roots that informed medieval interactions.40 Further, kissing was an important element of medieval ritual, as it signified the

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binding moment of various social contracts, including ceremonies of feudal homage, the rite of marriage and the kiss of peace. The use of a kiss in such contracts was not accidental. As an intimate interaction between two people,41 the kiss was an intensely physical experience that bound them together.42 For Francis, the kiss meant a physical transgression of the boundary between himself and the leper. While it was not until the fourteenth century that the idea that leprosy was contagious became entrenched, it is interesting to note here that Francis’s reaction to lepers is to cover his nose.43 Whether this action is due to the foul smell often associated with leprosy or an early hint at ideas about contagion and leprosy,44 it is certain that before his conversion Francis is overwhelmed by disgust. Kissing the leper, then, is the ultimate act of conversion for Francis. It is an intimate moment; a spiritual acceptance of the ‘bitter’; and an action that would bind Francis, and his legacy, to the leprous poor. It is within this context that this chapter will highlight the importance –​and the eventual impact –​of the kiss given to a leper in the plains below Assisi. The first biography of Saint Francis, the Vita prima,45 by Celano, was completed in 1228, only two years after his death. It was written to present the new saint to the Christian world as an exemplar of piety and grace. Unlike subsequent biographies, the Vita prima was not subject to the internal struggle of the Order, because it was written before the division became serious. Francis’s first vita was thus written in an environment without a motive for misrepresenting the saint. According to the Vita prima, shortly after renouncing his family and his inheritance Francis ‘moved to the lepers and stayed with them’.46 Francis not only lived among the lepers in their dwelling, but he ‘served all of them with great love. He washed the filth from them, and even cleaned out the pus of their sores.’47 Thomas explains that Francis, as a man of profound humility, did this repulsive task because it was God’s will. However, despite living among the lepers, Francis had not yet fully become a man of God. In the next paragraph of the Vita prima Thomas moves quickly through Francis’s final moment of conversion: When he started thinking of holy and useful matters with the grace and strength of the Most High, while still in the clothes of the world,

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he met a leper one day. Made stronger than himself, he came up and kissed him. He then began to consider himself less and less, until by the mercy of the Redeemer, he came to complete victory over himself.48

When Francis came upon a leper  –​the figure that was the most horrible sight to him –​his life was changed. Francis embraced what most repulsed him. By giving a kiss to a leper Francis was finally able to gain complete mastery over himself. This sequence of events of the Vita prima  –​moving to live with the lepers and then later kissing the single leper  –​would ultimately be reversed in all later versions of Francis’s biography. The significance of this change is twofold, first, because it makes more sense structurally for the narrative  –​if Francis, as Thomas explains, is living among the lepers when he meets the one whom he will kiss, he should not still find the sight of a leper as repulsive as before –​and second, because it places the greatest importance in Francis’s conversion on the kiss. This action of embracing the ‘bitter’ to gain the ‘sweet’ is the epitome of Francis’s spirituality. By having Francis’s first interaction with the leper come while he is still disgusted by them it shows, in a bold manner, Francis’s dramatic rejection of all secular things. As it stands, the order of the episodes in the Vita prima devalues the importance of this kiss. However, after the Vita prima was composed, and as things began to change within the Order, the image of Francis also began to fracture. The incident with the leper in Francis’s conversion began to take a dramatic turn with the rising Spiritual faction. In 1244 the newly elected Minister General of the Franciscan Order, Crescentius of Jesi, collected stories from brothers who had known Francis personally or had heard stories of his miracles.49 Crescentius, as an ardent opponent of the Franciscan Spirituals, hoped that an official compilation of documents on Francis’s life so soon after his death might assuage concerns raised by critics of the Franciscans within the Church. Although this collection of new sources did not in itself drastically alter the image of the saint, parts of it were used to create and augment new vitae of Francis that did.50 One text that made use of Crescentius’s documents was the Legend of the Three Companions, which claims to have been composed between 1241 and 1247.51 According to Rosalind Brooke, this account of Francis’s life is a ‘more comprehensive and

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more comprehensible account than can be found elsewhere among the early sources’.52 As such, it is an invaluable source among the collections written on Francis’s life. According to this text, after receiving a message from God in his dreams Francis met a leper on the road near Assisi. The Legend of the Three Companions places the emphasis of Francis’s conversion on this meeting with a single leper and the kiss Francis gave to him. However, the kiss in this text contains a key difference from Thomas’s Vita prima: One day he was riding his horse near Assisi, when he met a leper. And, even though he usually shuddered at lepers, he made himself dismount, and gave him a coin, kissing his hand as he did so. After he accepted a kiss of peace from him, Francis remounted and continued on his way. He began to consider himself less and less, until, by God’s grace, he came to complete victory over himself.53

Rather than Francis just kissing the leper, in the Legend of the Three Companions the leper returns Francis’s kiss with a ‘kiss of peace’. Here it is the leper who allows Francis to be victorious over himself. While these kisses exchanged between the leper and Francis on the road marked the moment of Francis’s conversion, this was followed by another interaction between Francis and the leprous. Unlike in the Vita prima, in the Legend of the Three Companions it is after the kiss on the road that Francis moves to the lepers’ dwelling. It was at the house of the lepers that Francis cemented his conversion and began his ministry to them. This is just as God had desired of him: After a few days, he moved to a hospice of lepers, taking with him a large sum of money. Calling them all together, as he kissed the hand of each, he gave them alms. When he left there, what before had been bitter, that is, to see and touch lepers, was turned into sweetness … With the help of God’s grace, he became such a servant and friend of the lepers.54

From the moment he exchanged kisses with the leper on the road Francis associated the leprous with his ultimate mastery over himself. Despite the disgust he had felt towards lepers in his youth, with each kiss and coin that Francis gave to the lepers at the hospice he reinforced his transition to his new life. Roughly around the same time that the Legend of the Three Companions was written, another official biography of Francis

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was composed for the Franciscan Order. In 1244, only fifteen years after the completion of the Vita prima, Thomas of Celano was commissioned by Crescentius of Jesi to write another biography of Saint Francis. The aim of this new vita was to augment the previous version by bringing in the stories from the brothers who had known and been close to Francis.55 Despite the motives of the Minister General to strike out against the Spirituals, The Remembrance of the Desire of a Soul, or the Vita secunda as it is commonly known, provided further details on the life and teachings of Francis and attempted to present a picture of the saint that might satisfy both constituencies within the Order.56 The episode in the Vita secunda of Francis’s conversion through the kissing of the leper is a marked departure from Thomas of Celano’s first biography of the saint. After receiving direction from God to trade the ‘sweet’ for the ‘bitter’, Francis ‘was moved to obey immediately the divine command, and was led through experience to the truth of these things’.57 Changing the order of events from Thomas’s previous vita, Francis was first confronted with the leper in the plains below Assisi: Among all the awful miseries of this world Francis had a natural horror of lepers, and one day as he was riding his horse near Assisi he met a leper on the road. He felt terrified and revolted, but not wanting to transgress God’s command and break the sacrament of His word, he dismounted from his horse and ran to kiss him. As the leper stretched out his hand, expecting something, he received both money and a kiss. Francis immediately mounted his horse and although the field was wide open, without any obstructions, when he looked around he could not see the leper anywhere.58

Instead of being a moment of conversion, the Vita secunda treats the kiss given to the leper as the fulfilment of God’s plan. In the Vita prima Thomas shows Francis calmly approaching the leper and then kissing him. In the Vita secunda, however, Thomas depicts the approach to the leper as something about which Francis is hesitant. In fact, in this version of the episode, the only reason Francis approaches the leper at all is so as not to go against God. To ensure that he does what God wants of him –​instead of what he himself wants –​Francis has to run to the leper. Understanding that God wished that lepers be embraced and cared for, he ‘made his way to the houses of the lepers and,

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giving money to each, he also gave a kiss on the hand and mouth. Thus he took the bitter for the sweet and courageously prepared to carry out the rest.’59 Another key departure from earlier vitae of Francis is the disappearance of the leper at the end of this episode in the Vita secunda. Having turned the ‘bitterness’ of the leper into the ‘sweetness’ of God with a kiss, Francis looked around, searching for the leper who was nowhere to be seen. This supernatural element is an addition by Thomas of Celano that was carried further in later vitae and stories of Saint Francis. The leper’s mysterious disappearance suggests that the he was a divine tool who was sent in order to facilitate Francis’s final moment of conversion.60 In future versions (mostly those written by Spiritual authors) this element was so augmented that the leper was eventually considered to have been Christ, disguised to test Francis’s devotion. By the middle of the thirteenth century these multiple depictions of Francis had been disseminated across the medieval world –​both within and outside the Franciscan Order. On 2 February 1257, Bonaventure was appointed to the position of Minister General by the Conventuals to try to restore a sense of unity to the diverging Order.61 At the conclusion of the General Chapter in Narbonne in 1260, Bonaventure was asked to write a new vita of Saint Francis to bring uniformity to the diverse materials on the life of the Order’s founder.62 This new biography of Saint Francis, the Legenda major, was also meant to pacify the growing dissent within the Order. In 1266, at the General Chapter meeting, Bonaventure’s Legenda major was declared to be the only official vita of Francis’s life. In a hope to end the internal division plaguing the Order,63 all other documents regarding Francis’s life were forbidden, and were collected and burnt.64 The Legenda major provides the longest and most descriptive version of the leper’s role in Francis’s conversion to a spiritual life. Before meeting the leper, Francis was searching for a way to complete his transition to an entirely spiritual life; ‘he was removing himself from the pressure of public business, he would eagerly beg the divine kindness to show him what he should do’.65 According to Bonaventure, Francis was still unsure of how he would be able fully to overcome himself in favour of the spiritual. All Francis knew

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was that ‘it was suggested to his spirit that a spiritual merchant must begin with contempt for the world and a knight of Christ with victory over one’s self’.66 Again in the Legenda major, while trying to work out how fully to become a master over himself, Francis comes upon a leper while riding his horse on the plains below Assisi: This unforeseen encounter struck him with not a little horror. Recalling the plan of perfection he had already conceived in his mind, and remembering that he must first conquer himself if he wanted to become a knight of Christ, he dismounted from his horse and ran to kiss him. As the leper stretched out his hand as if to receive something, he gave him money with a kiss.67

In this text Bonaventure highlights how the meeting between Francis and the leper was one that Francis was not prepared for. Francis was still ‘in this world’ when he came upon the leper, because the meeting still filled him with horror and disgust. Despite that, he was able to overcome his aversion and embrace the leper in the manner that was in line with God’s desire. To become a ‘knight of Christ’ Francis imitated the New Testament actions of Jesus (Luke 17:11–​19, 5:12–​16; Matthew 8:1–​4) by showing mercy to the leper he met on the road. By running towards the leper Francis is seen as having an intense desire to complete his conversion and leave the secular world completely behind. Francis is running away from his previous life and into the arms of his new one. Bonaventure next follows in the tradition that was started by Thomas of Celano in the Vita secunda. After Francis had kissed the leper and given alms, ‘Immediately mounting his horse, however, and turning all around, even though the open plain stretched clear in all directions, he could not see the leper anywhere. He began, therefore, filled with wonder and joy, to sing praises to the Lord, while proposing, because of this, to embark always on the greater.’68 Bonaventure paid more attention to the disappearance of the leper than did Thomas of Celano. For Bonaventure, it was the combination of meeting the leper and the leper’s disappearance that solidified, in Francis’s mind, his desire to complete his conversion to this new life. The disappearance of the leper here is seen as an affirmation by God to Francis of what he had done.

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A little later in the text of the Legenda major, Bonaventure expands even further upon Francis’s growing humility and devotion to lepers within his new mode of life. Francis, as a logical extension of his conversion, moved to live with and care for the lepers. ‘He washed their feet, bandaged sores, drew pus from wounds and wiped away filth. He who was soon to be a physician of the Gospel even kissed their ulcerous wounds out of his remarkable devotion.’69 Francis understood that God, to test his faithfulness, brought the leper to him when he was riding his horse in the plains below Assisi. After that moment, particularly because of the disappearance of the leper, Francis believed that serving lepers was the ultimate act of humility. The lepers were responsible for his leaving behind his old life and, as such, he viewed serving and caring for them as a vital component of his new life. Despite the Legenda major being designated as the only official life of Francis recognised by the Franciscan Order after 1260, other vitae of the saint were still written subsequently. One such text is a prominent Spiritual text that is commonly referred to as the Legend of Perugia.70 The collection emphasises the unrelenting spirituality of Francis. According to this collection Francis observed the Gospels literally from the moment of his conversion until his death. Therefore, the moment of his conversion was not important to Francis’s life, as his ‘real’ life only began once he had finally become master over himself. Because of this, the episode of Francis meeting and kissing the leper is not included. Despite its omission, the leper still remains an important figure in this biography. To associate with lepers in the Legend of Perugia served as a testament to Francis’s humility. This becomes clearly evident in an episode where Francis is returning to Saint Mary of Portiuncula from a trip. There he sees a Franciscan brother called James the Simple ministering to a severely disfigured leper. Brother James was considered to be like a doctor to the lepers with the worst sores because ‘he gladly touched, changed, and treated their wounds.’71 Because of these actions James is seen as the type of brother whom Francis readily approved of within the Order.72 Despite Francis’s desire to humble himself to the leprous, he reacts in a strange manner upon seeing Brother James with the leper at the church:

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As if reproving Brother James, blessed Francis told him: ‘You should not take our Christian brothers about in this way since it is not right for you or for them.’ Blessed Francis used to call lepers ‘Christian brothers’. Although he was pleased that Brother James helped and served them, the holy father said this because he did not want him to take those with severe sores outside the hospital. This was especially because Brother James was very simple, and he often went with a leper to the church of Saint Mary, and especially because people usually abhorred lepers who had severe sores.73

Immediately, Francis believed what he had said to Brother James might have been insulting to the leper, and he was determined to atone for his behaviour: Francis said:  ‘Let this be my penance:  I will eat together with my Christian brother from the same dish.’ While blessed Francis was sitting at the table with the leper and other brothers, a bowl was placed between the two of them. The leper was completely covered with sores and ulcerated, and especially the fingers with which he was eating were deformed and bloody, so that whenever he put them in the bowl, blood dripped into it.74

This story exemplifies the two-​part motivation of the Spirituals: they wanted to present an image of Francis based on how his companions remembered him, and also to present an image of him that would keep the Order and the Brothers in strict observance of Francis’s views and principles.75 This story of Francis eating with the leper promoted the figure of a saint who humbled himself by sharing a bowl with a leper. This is an image that was not to be easily erased from the memory of contemporaries, but also one that would not be replicated in any other written source on the life of Saint Francis. It seems, therefore, in light of the controversies plaguing the Order, that the most appropriate place to conclude this chapter is with a consideration of how Francis himself wanted to present the role of the leper in the life of ‘Saint Francis of Assisi’.76 In his Testament,77 the closest document to an autobiography by the saint, Francis places the figure of the leper in a noticeably prominent position. The opening lines of this document read: The Lord gave me, Brother Francis, thus to begin doing penance in this way:  for when I  was in sin, it seemed too bitter for me to see lepers. And the Lord Himself led me among them and I showed mercy

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to them. And when I left them, what had seemed bitter to me was turned into sweetness of soul and body. And afterwards I delayed a little and left the world.78

Francis understood that God had brought him to the lepers and that through interacting with them he was able fully to let go of all worldly ideals. Before this happened he was in sin, and only after the Lord led him to the lepers was he able completely to leave the secular world behind. Although Francis does not chronicle his actual meeting of the leper in his Testament, he does show to his readers how important the meeting was to his life. He acknowledges how horrifying the lepers had once been to him, but also explains how it took God’s intervention to show him the error of his ways. It is through this passage that Francis conveys an important message to contemporary society: lepers were not to be avoided and cast out, but were to be embraced and cared for. With the placement of lepers at the beginning of his personal Testament he highlights their role as being the final, and perhaps ultimate, catalyst for his conversion.

Conclusion Saint Francis of Assisi was by no means the first holy man or woman to kiss a leper, nor would he be the last. Physically to cross the boundary between the clean and the unclean –​the holy figure and the leper –​had long been looked upon as the ultimate gesture of humility. Though still within a longstanding tradition, Francis’s actions were in many ways revolutionary. Where the kiss of Martin of Tours had healed the leper from his physical deformities, Francis’s kissing of the leper healed his own soul. Like a mirror, the kiss given to the leper allowed Francis finally to see himself clearly.79 Because of that moment of self realisation Francis was able to trade the ‘bitter’ for the ‘sweet’. Although he did not heal the leper, Francis helped to usher in a new understanding of the disease –​one that encouraged compassion towards and care of the leprous. Francis’s impact on the medieval world is undeniable. The paradigm of kissing the leper continued to affect devotional discourse

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as well as religious life through the remainder of the Middle Ages and well into the modern era.80 Through the dissemination of the vitae, Francis’s example decisively influenced the evolving religious and social understandings of leprosy, and reinforced the religious identities of leprosy sufferers within leprosarium communities.81 A  central tenet of his Order was ministering to the poor and the sick, specifically lepers. Brothers  –​according to early statutes  –​ were expected to live among lepers for a period of time, humbling themselves much in the same way that Christ had centuries earlier. Francis’s legacy also extended beyond the boundaries of his Order. As Christianity experienced a sense of renewal, many other individuals followed closely in Francis’s footsteps. Showing compassion towards a leper became an indicator of humility, sanctity and God’s favour. Through all his reported interaction with the leprous, Francis’s hagiography emphasised the image of the leper as a pauper, deserving of charity and Christ-​like. Though both negative and positive responses to leprosy co-​existed in the twelfth and thirteenth centuries, Francis’s gift of money to the leper in the fields below Assisi, as well as his provision of charity to leper houses, set a powerful example. As there was already a growing emphasis on charity at this time, Francis’s actions were not necessarily radically transformative. However, he undoubtedly highlighted lepers’ status as a group specially chosen by God to suffer on earth and be saved, and spurred the rise in charitable donations to leprosaria. Further, where the later versions of Francis’s vitae hinted at the leper being Christ in disguise, there was also an association of the suffering of the leper with the suffering of Christ. Despite the impact of the controversy within the Franciscan order on the evolving nature of Francis’s vitae, all versions of his life served to reinforce these positive images of the leper. Within Francis’s lifetime, and for centuries following it, other saints’ vitae included episodes with lepers as central figures. Francis’s kiss directly informed these vitae, as well as collections of sermons and exempla. Included among the saints is Elisabeth of Hungary, who was a follower of Francis, though not a member of the Order. In one episode of her vita, Elisabeth took into her home a leper whom no one else would go near. She bathed him

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and tended to his wounds, and then laid him in her and her husband’s bed. When her husband came to see what was going on, he instead saw an image of the crucified Christ.82 Likewise, Saint Hedwig of Silesia, Elisabeth’s aunt, washed the feet of several lepers as an act of humility.83 Though these two women are just a sample of the hagiographic legacy left by Francis, they provide evidence for the changing social understanding of the disease at this time. The extensive hagiographic tradition that developed around the legacy of Francis in the central Middle Ages, although manipulated to suit contemporary purposes, helped to change responses and attitudes to lepers. It was within this moment  –​one of revival, reflection and broader social changes –​that Francis stepped forward and embraced the most repulsive figure in medieval society. In reviving the idea of living in imitatio Christi Francis brought caring for –​and indeed kissing –​lepers to a more central position within both religion and society.

Notes 1 This chapter is based on the third chapter of my M.A. thesis, ‘Malady or miracle? The influence of St Francis on the perception of leprosy in the high Middle Ages’ (Central European University, 2011). I  am grateful to Dr Elma Brenner and Dr Anna M. Peterson for their feedback and support throughout the production of this chapter, and to Dr Luke Demaitre for his support and encouragement throughout the writing of my thesis. 1 R. J. Armstrong, J. A. W. Hellmann and W. J. Short (eds), Francis of Assisi:  Early Documents, 3 vols (New  York:  New City Press, 1999–​ 2001), Vol. I: The Saint (1999), p. 124. 2 It is important to note here that the term ‘leper’ and its variants will be used throughout this chapter. The term is, indeed, controversial and loaded with stigma within modern society. In many regions of the world, people with leprosy still face ‘lifelong rejection, stigma and discrimination’. Even individuals who have been cured ‘are shunned by society and forced to live as outcasts. India has an estimated 1,000 leprosy colonies that are home to hundreds of thousands of people living their lives in the disease’s long dark shadow.’ R. Cookson and S.  Rhodes, ‘Leprosy:  India’s hidden disease,’ Guardian, 24 March

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2011, available at www.theguardian.com/​lifeandstyle/​2011/​mar/​24/​ leprosy-​india-​hidden-​disease (accessed 22 October 2020). However, the term ‘leper’ is used in this chapter in order to reflect the language of the sources. Its use is not intended further to perpetuate the stigma of the disease, but rather to reflect historical reality. 3 For a more detailed discussion on the special religious status of lepers, see D. Jeanne, Chapter 3 in this volume. For a more general discussion on charity in the Middle Ages, see J. Brodman, Charity and Religion in Medieval Europe (Washington, DC:  Catholic University Press, 1650 2009); and A. M. Scott (ed.), Experiences of Charity, 1250–​ (Farnham: Routledge, 2015). 4 As François-​Olivier Touati has shown, leprosaria were often founded with the intention of converting lepers to the religious life, thus placing the lepers themselves among the category of the religious and, therefore, making them even more worthy of charity and compassion. F.-​ O. Touati, ‘Les léproseries aux XIIème et XIIIème siècles, lieux de conversion?’, in N. Bériou and F.-​O. Touati (eds), Voluntate Dei leprosus:  Les lépreux entre conversion et exclusion aux XIIème et XIIIme siècles, Testi, Studi, Strumenti, 4 (Spoleto: Centro italiano di studi sull’Alto medioevo, 1991), pp. 1–​32. 5 The doctrine of purgatory was formalised in 1274, but was influential before this date. 6 See F.-​O. Touati, Chapter 2 in this volume. 7 P. Brown, ‘The saint as exemplar in Late Antiquity’, Representations, 2 (1983), 1–​25 (p. 7). 8 G. Klaniczay, ‘Legends as life strategies for aspirant saints in the later Middle Ages,’ Journal of Folklore Research, 26(2) (1989), 151–​71 (p. 152). 9 For a more complete discussion on the life of Saint Martin of Tours, see R. Pernoud, Martin of Tours:  Soldier Bishop, and Saint, trans. M. J. Miller (San Francisco:  Ignatius Press, 2006); and C. Stancliffe, St Martin and His Hagiographer:  History and Miracle in Sulpicius Severus (Oxford: Clarendon Press, 1983). 10 ‘He [Martin] gave a kiss to a leper, of miserable appearance, while all shuddered at seeing him do so.’ Sulpitius Severus, ‘On the Life of St Martin’, trans. A. Roberts, in P.  Schaff and H.  Wace (eds), A Select Library of Nicene and Post-​Nicene Fathers of the Christian Church, 14 vols, Vol XI (New York: J. J. Little, 1894), 3–​17 (p. 12), available at https://​www.questia.com/​read/​123157254/​a-​select-​library-​of-​nicene-​ and-​post-​nicene-​fathers. In Latin:  ‘… leprosum miserabili facie horrentibus cunctis osculatus est atque benedixit’:  Sulpitius Severus, Vita sancti Martini (Paris: Editions du Cerf, 1967), p. 292.

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11 Sulpitius Severus, ‘On the Life of St Martin,’ p. 11. ‘Statimque omni malo emundatus’: Sulpitius Severus, Vita sancti Martini, p. 292. 12 C. Peyroux, ‘The leper’s kiss,’ in S. Farmer and B. H. Rosenwein (eds), Monks and Nuns, Saints and Outcasts: Religion in Medieval Society (Ithaca, NY: Cornell University Press, 2000), pp. 172–​88 (p. 180). 13 Rawcliffe, Leprosy, p. 144. 14 Touati, Maladie, p. 88. 15 Peyroux, ‘The leper’s kiss,’ p. 181. 16 Venantius Fortunatus, ‘The Life of the Holy Radegund’, trans. J. McNamara, J. E. Halborg and E. G. Whatley, in J. McNamara, J. E. Halborg and E. G. Whatley (ed. and trans.), Sainted Women of the Dark Ages (Durham, NC: Duke University Press, 1996), p. 78. 17 Ibid. 18 For more on this topic, see M. D. Chenu (ed.), Nature, Man and Society in the Twelfth Century:  Essays on the New Theological Perspectives in the Latin West (Chicago: University of Chicago Press, 1997); S. Epstein, An Economic and Social History of Later Medieval Europe, 1000–​1500 (Cambridge: Cambridge University Press, 2009); P. M. Hohenberg and L. Hollen Lees, The Making of Urban Europe 1000–​1994 (Cambridge:  Harvard University Press, 1995); L. K. Little, Religious Poverty and the Profit Economy in Medieval Europe (London: P. Elek, 1978). 19 C. H. Lawrence, The Friars:  The Impact of the Early Mendicant Movement on Western Society (London: Longman Group, 1994), p. 1. 20 Ibid., p. 3. 21 Ibid., p. 17. 22 According to Jacques Le Goff it was the growth of this division during Francis’s lifetime that prompted his early return from the Holy Land in 1220 and the composition of a new Rule in 1221. This conflict was also why Francis resigned from leadership of the Order. J. Le Goff, Saint Francis of Assisi, trans. C. Rhone (Routledge: London, 2004), p. 17. 23 For more detailed investigations into the rise of Spiritual Franciscans as well as their issues with Conventual Franciscans, see D. Burr, The Spiritual Franciscans: From Protest to Persecution in the Century after Saint Francis (University Park:  Pennsylvania State University Press, 2001); and G. Leff, Heresy in the Later Middle Ages:  The Relation of Heterodoxy to Dissent c. 1250–​c. 1450 (Manchester: Manchester University Press, 1999). 24 R. B. Brooke, The Image of St Francis: Responses to Sainthood in the Thirteenth Century (Cambridge:  Cambridge University Press, 2006), p.  106. According to Burr the Spirituals sought to act in a manner as close to what Francis originally wanted for himself and his Order.

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‘Francis’s basic goal was the sort of self-​emptying he saw in Christ, a behavior that involved not only humility but also love.’ Burr, The Spiritual Franciscans, p. 2. 25 Burr, The Spiritual Franciscans, p. 4. The Order was growing rapidly, and, by the fourteenth century, it had risen to over 30,000 members across Europe and into Africa and Asia. Armstrong, Hellmann and Short, Francis of Assisi: Early Documents, Vol. II: The Founder (2000), p. 496. 26 For more detailed and extensive discussions on Francis’s life see Brooke, The Image of St Francis; J. Dalarun, François d’Assise:  Principes et modalités du gouvernement dans l’ordre des Frères mineurs (Paris:  De Boeck & Larcier, 1999); C. Frugoni, Francis of Assisi:  A Life (New  York:  Continuum, 1989); Le Goff, Saint Francis of Assisi; M. Robson, Saint Francis of Assisi:  The Legend and the Life (London:  Continuum, 1997); R. Rusconi, Francis of Assisi in the Sources and Writings (New  York:  Franciscan Institute, 2008); and R.  C. Trexler, Naked before the Father:  The Renunciation of Saint Francis of Assisi (New York: P. Lang, 1989). 27 F.-​O. Touati, ‘François d’Assise et la diffusion d’un modèle thérapeutique au XIIIe siècle,’ Histoire des sciences médicales, 16 (1982), 175–​84 (p. 175). 28 Le Goff, Saint Francis of Assisi, p. 13. 29 Brooke, The Image of St Francis, p. 13. Brooke explains that despite his desire not to be noticed, his popularity grew and placed him at the centre of attention of many. ‘Popular devotion to the living holy man presented him with problems. He had to guard against the adulation going to his head and corrupting him; at the same time he had to fulfill, to their satisfaction and his own, the expectations he aroused.’ Brooke, The Image of St Francis, p. 29. 30 Thomas of Celano, ‘Vita prima’, in Armstrong, Hellmann and Short, Francis of Assisi: Early Documents, Vol. I, p. 183. 31 Le Goff, Saint Francis of Assisi, p. 26. 32 M. Robson, The Franciscans in the Middle Ages (Woodbridge: Boydell Press, 2006), p. 14. 33 Thomas of Celano, ‘Vita secunda’, in Armstrong, Hellmann and Short, Francis of Assisi: Early Documents, Vol. II, p. 248. 34 Le Goff, Saint Francis of Assisi, p. 28. 35 Thomas of Celano, ‘Vita secunda,’ p. 248. Latin: ‘leprosos naturaliter abhorrens’. E. Menestò and S. Brufani (eds), Fontes Franciscani (Assisi: Edizioni Porziuncola, 1995), p. 451. 36 An ‘unpleasant stench’ associated with lepers’ breath or skin is often commented on by medieval authors as a particularly gruesome

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symptom of the disease, particularly after the turn of the thirteenth century. F.-​ O. Touati, ‘Contagion and leprosy:  Myth, ideas and evolution in medieval minds and societies’, in D. Wujastyk and L. I. Modern Societies Conrad (eds), Contagion:  Perspectives from Pre-​ (Aldershot: Ashgate, 2000), pp. 179–​202 (p. 188). 37 Thomas of Celano, ‘Vita prima’, p. 195. 38 Here ‘all versions of this story’ refers to the vitae that tell of Francis’s conversion by the leper in the plains below Assisi. There are versions of Francis’s vita that do not talk about his conversion process (the Legend of Perugia, for example, does not chronicle Francis’s life before his conversion, which will be discussed later in this chapter), and as such cannot be grouped into this category. 39 For a discussion on kissing in the Middle Ages, see J. R. Major, ‘ “Bastard feudalism” and the kiss:  Changing social mores in late medieval and early modern France,’ Journal of Interdisciplinary History, 17(3) (1987), 509–​35; J. Orlemanski, ‘How to kiss a leper’, postmedieval:  A Journal of Medieval Cultural Studies, 2(2) (2012), 142–​57; K. Petkov, The Kiss of Peace: Ritual, Self, and Society in the High and Late Medieval West (Leiden: Brill, 2003); and Peyroux, ‘The leper’s kiss’. 40 For example, the kiss is a common element of biblical greetings: Paul encouraged the faithful to ‘greet each other with a sacred kiss’ (I Corinthians 16:20), while Jesus commented on how Simon the Pharisee did not welcome him with a kiss (Luke 7:45, ‘You did not give me a kiss’). J.  R. Major notes how the ‘early Christians were especially noted for their custom of kissing’: Major, ‘Bastard Feudalism’, p. 509. 41 Julie Orlemanski calls the kiss an ‘ “interface”: it is paradigmatically what is between faces, an event, an experience, an exchange of touch, the shared and mutually constituted pressure between two surfaces’. Orlemanski, ‘How to kiss a leper’, p. 146. 42 Petkov, The Kiss of Peace, p. 11. 43 In the fourteenth century, especially with the arrival of the Black Death, the idea that disease was transmitted through corrupt air (miasma) became widespread. Leprosy was among the diseases understood to be transmitted in this way. For a more in-​ depth discussion on ideas of contagion and leprosy in the Middle Ages, see Touati, ‘Contagion and leprosy’; and F.-​O. Touati, ‘Historiciser la notion de contagion:  L’exemple de la lèpre dans les sociétés médiévales’, in S. Bazin-​Tacchella, D. Quéruel and E. Samama (eds), Air, miasmes et contagion: Les épidémies dans l’antiquité et au Moyen 88. Also see Age (Langres:  Cominique Guéniot, 2001), pp.  157–​

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L. Demaitre’s discussion of ‘Dreaded alarm, or call for kindness?’, in Chapter in 8 this volume (pp. 241–​6). 44 On associations of leprosy with contagion before the fourteenth century, see E. Brenner, Chapter 6 in this volume (pp. 172–​4). 45 Robson, Saint Francis of Assisi, p. vi. 46 Armstrong, Hellmann and Short, Francis of Assisi: Early Documents, Vol. I, p. 195. 47 Armstrong, Hellmann and Short, Francis of Assisi: Early Documents, Vol. I, p. 195. 48 Thomas of Celano, ‘Vita prima’, p. 195. 49 R. B. Brooke, Early Franciscan Government:  Elias to Bonaventure (Cambridge: Cambridge University Press, 1959), p. 247. 50 Brooke, The Image of St Francis, p. 102. 51 It is uncertain if this compilation is the direct result of Crescentius’s collection, as the dating of this text has been difficult for historians. Attached to the document is a letter that was supposedly written by Brothers Leo, Rufino and Angelus, and is dated to 11 August 1246. However, the writing within the text suggest a series of serious questions that point to a later date of production. Armstrong, Hellmann and Short, Francis of Assisi: Early Documents, Vol. I, p. 16. For a more detailed discussion of this issue, see Brooke, The Image of St Francis, pp. 147–​9. 52 Brooke, The Image of St Francis, p. 157. 53 ‘Legend of the Three Companions’, in Armstrong, Hellmann and Short, Francis of Assisi: Early Documents, Vol. II, p. 74. 54 Ibid. 55 Le Goff, Saint Francis of Assisi, p. 21. 56 Brooke, The Image of St Francis, p. 140. 57 Thomas of Celano, ‘Vita secunda’, p. 248. 58 Ibid., pp. 248–​9. 59 Ibid., p. 249. 60 Peyroux, ‘The leper’s kiss,’ p. 173. 61 Brooke, The Image of St Francis, p. 242. 62 Armstrong, Hellmann and Short, Francis of Assisi: Early Documents, Vol. II, p. 495. 63 Despite the intentions of the Legenda major, according to Le Goff it did not include any text that could show that the Franciscan Order had deviated from Francis’s axiomatic intentions. Le Goff, Saint Francis of Assisi, p. 20. 64 Robson, Saint Francis of Assisi, p. 7. 65 Armstrong, Hellmann and Short, Francis of Assisi: Early Documents, Vol. II, p. 533.

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66 Ibid. 67 Ibid., p. 533. 68 Ibid., pp. 533–​4. 69 Ibid., p. 539. 70 The Legend of Perugia has been published under a number of different titles, including ‘Legenda Antiqua [Ancient Legend], I Fiondi dei Tre Compagni [The Flowers of the Three Companions], Scripta Leonis, Rufini et Angeli Sociorum S.  Francisci [The Writings of Leo; Rufino and Angelo, Companions of St Francis], Legenda Perugina [Legend of Perugia] and Compilatio Assisiensis [The Assisi Compilation]’. Armstrong, Hellmann, and Short, Francis of Assisi: Early Documents, Vol. I, p. 16. 71 ‘Legend of Perugia’, in Armstrong, Hellmann and Short, Francis of Assisi: Early Documents, Vol. II, p. 166. ‘Changed’ here presumably means changing the dressings or bandages on the wounds. 72 According to Brooke, ‘Brother James is revealed as the kind of brother Francis warmly approved of  –​even if he did not care for all his actions: a simple lay brother, who could help other poor folk and the afflicted and set them an example for Christian living. It also exemplifies the paradox of authority within the Order.’ Brooke, The Image of St Francis, p. 121. 73 ‘Legend of Perugia’, p. 166. 74 Ibid., p. 167. 75 Brooke, The Image of St Francis, p. 120. 76 Despite all his writings dealing with his vision of the Order, Francis never composed any truly autobiographical material. Therefore, according to Le Goff, Francis’s own writings are not the most useful in attempting to generate a picture of who Francis was or the image he was trying to project of himself. Le Goff, Saint Francis of Assisi, pp. 14–​17. This issue makes knowing the image of Francis, as Francis intended, a difficult task. 77 The Testament was dictated by Francis and completed shortly before his death in October 1226. It has been considered one of his most controversial documents. He was adamant that it not be considered a binding document or another version of the Rule. Instead, he wanted it to be a remembrance of the things God had called him to do. Francis ‘declared that he was writing it “so that we may observe in a more Catholic manner the Rule which we have promised to the Lord” ’. R. J. Armstrong and I. C. Brady (ed. and trans.), Francis and Clare: The Complete Works (New York: Paulist Press, 1982), p. 153. 78 Armstrong and Brady, Francis and Clare, p. 124.

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79 Touati, ‘François d’Assise et la diffusion d’un modèle thérapeutique,’ p.  179:  ‘La vision du lépreux agit comme un miroir de sa propre condition de pécheur; franchir le pas –​embrasser le lépreux –​signifie reconnaître humblement cette condition partagée par tous et en accepter les conséquences:  prendre part individuellement aux souffrances du Sauveur.’ 80 Orlemanski, ‘How to kiss a leper’, p. 143. 81 See C. Rawcliffe, Chapter 4 in this volume. 82 Die Vita der heiligen Elisabeth des Dietrich von Apolda, ed. M. Rener (Marburg: Elwert, 1993) (interpolation in) Book II, Chapter 7, pp. 40–​1: ‘Alio tempore in castro Nuemburg dominus Ludwicus lantgravius cum Sophia matre sua et sancta Elysabeth coniuge sua simul erant. Tunc amatrix humilitatis misericordieque cultrix, Elysabeth, lotum in balneo lecto principis leprosum quendam reclinavit. Quo comperto socrus, apprehensa manu filii sui, duxit ipsum ad lectum dicens: “Recognosce modo, quod his solet Elysabeth stratum tuum inficere.” Tunc aperuit deus devoti principis interiores oculos viditque in thoro suo positum crucificum. Qua contemplacione consolatus pius princeps rogavit sacram coniugem suam, ut in stratu suo tales leprosos frequenter collocaret. Intellexit enim, quod in membris suis infirmis suscipitur Christus dominus et fovetur.’ As translated in O.  Gecser, ‘Lives of St Elizabeth:  Their rewritings and diffusion’, Analecta Bollandiana, 127(1) (2009), 49–​107 (pp. 94–​5). 83 ‘In cena domini specialiter illus amore, qui pro nobis ut leprosus voluit estimari, pedes abluit leprosorum et novis eosdem leprosos, quos laverat, vestibus induebat.’ A. Szemkowicz (ed.), Monumenta Poloniae historica, Vol. IV (Warsaw:  Państwowe Wydawnictwo Naukowe, 1960–​61), p. 522.

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10 From pilgrim to knight, from monk to bishop: the distorted identities of leprosy within the Order of Saint Lazarus Rafaël Hyacinthe Introduction: leprosaria versus militia The Order of Saint Lazarus of Jerusalem has intrigued many researchers, reflecting not only the modern-​day revival of this crusading order that was first established in Jerusalem, but also attention to its origins, characteristics and significance.1 As part of their presence in the Holy Land following the victory of the First Crusade (1095–​ 99), the Latin crusaders established a leprosarium outside the walls of the city of Jerusalem, near the tower named after Tancred. It has been argued that its origins date from an earlier eastern establishment, but lack of precise sources unfortunately prevents us from confirming this fact.2 The first texts to mention it precisely date from the third decade of the  twelfth century, as a simple shelter for leprosy patients, and from then on, it evolved quickly.3 The sick lived together, and soon formed a religious community, recognised by the other monastic communities nearby. Almost from the beginning, the community’s members were devoted to Saint Lazarus, the friend of Christ from Bethany, who walked out of his tomb to follow Christ’s voice (John 11:1–​44). His story evoked the resurrection that the sick could hope to achieve after their physical deterioration. Along with his namesake, the beggar carried in the bosom of Abraham by angels (Luke 16:19–​31), he stands out as an exemplar, a composite source that others could be identified with.4 Though there were of course other patrons of medieval leprosaria, Lazarus was strongly associated with leprosy sufferers at that time.5

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The chance to visit or support the convent of Saint Lazarus formed part of the range of penitential opportunities available to the pilgrims who arrived in Jerusalem. The pilgrims assisted the leprosy sufferers, by giving alms or entering the community as healthy brethren to care for the sick.6 It was significant that they assisted a group who would not recover from their sickness since, during the crusading period, to die in the city of Jerusalem was considered close to martyrdom. Furthermore, this particular sickness was considered to be a sign of God,7 and was closely associated with Christ, crucified at Jerusalem. This new community of the sick at Jerusalem thus had a special significance.8 This chapter will probe the identity and status of the brethren of Saint Lazarus, and will consider how their identity changed between the twelfth and thirteenth centuries. It will especially consider what it meant, in the mid-​thirteenth century, for knights suffering from leprosy to be actively engaging in combat. Did those who were fighting indeed have leprosy, or were there healthy members of the order who assumed military duties? All brethren of Saint Lazarus were still identified with the disease and its sufferers, and providing for the sick remained a focus of the Order even after the sick knights retreated from military duties in the second half of the thirteenth century. The shifting identities of the knights of Saint Lazarus in the twelfth and thirteenth centuries shed light on responses to leprosy in both the East and the European West, and on the particular place of leprosy sufferers in the military setting of the crusades. From 1187, when Jerusalem was lost to the Christians following their defeat by Saladin, the Order of Saint Lazarus entered a second phase of existence. After that date, just as the crusading ideal had to adapt to a new geopolitical context, the Order itself also had to evolve.9 One of the major features of this evolution was linked to a wider conceptual adaptation of the goal of crusading. By the beginning of the thirteenth century, encouraged by the papacy, western Christians who took the crusading vow engaged themselves in an intense struggle to recover the Holy Land. The latter thus became a focus of active warfare, rather than of pilgrimage and penitential activities.10 This shift affected the various crusading orders, which became increasingly military in emphasis. In the initial decades following the First Crusade, the only real military Order was that of the Templars, whose brethren vowed to

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fight for the Cross. But by the first half of the thirteenth century, there were several other military Orders. The brethren of Saint John of Jerusalem, who initially focused on providing charity and hospital care, progressively took on a military function. Their new statutes, drawn up in 1203, confirm this evolution: not only were the brethren to care for the sick, but they were also to take up arms whenever possible to sustain the cause of the faith against the Infidels.11 In Acre, a hospital for German pilgrims had become the headquarters of a new military Order, the Teutonic Order, by 1198. It would appear that, from this point on, a military investment was obligatory for every regular and secular foundation. For example, the canon friars of Saint Thomas, founded in Acre by 1228, were soon recognised as a military Order, albeit one of a fairly minor status. Almost all the crusading Orders thus concentrated their actions and resources on warfare, adjusting and reorientating the crusading ideal that had been initiated more than a century earlier.12 This was also the case for the Order of Saint Lazarus. After a period of silence, which followed the destruction of its first convent located outside the walls of Jerusalem during the siege of 1187, it progressively reappears in the documentary sources. Between 1216 and 1228, Walter of Novo Castro, master of the Order, requested official confirmation and recognition for grants of property in places still included in the diminishing Crusader States. In 1234, his successor, Renaud de Flori, did the same. Thanks to the support they found, by 1240 the brethren of Saint Lazarus had established themselves in a new convent in Acre, the new capital of the Latin kingdom of the East, a little more than half a century after the loss of Jerusalem.13 From then on, papal support for the Order was addressed not to a leprosarium community, as had occasionally been the case up to 1234, but to a hospitaller and military Order just like that of Saint John. In 1255, Pope Alexander IV granted and confirmed the use of the Rule of Saint Augustine for the development of the Order.14 By 1262, Urban IV had released the Lazarites from episcopal control, thus granting them greater autonomy.15 The evolution of the hospitaller convent into a crusading militia is documented through its normative texts. The Rule of Saint Lazarus itself is the most useful of these documents. Unfortunately it survives only as a fourteenth-​century copy in German, gathering together two

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distinctive parts.16 The first part was drawn up ‘in Jerusalem’, hence between 1130 and 1187. It deals with the situation of the leprosy sufferers: how, as martyrs in Jerusalem, they were to be cared for devoutly, carried to church and prayed for by healthy brethren making the vow to help them on their way through physical decay to death. But an additional section was added, dating from the last third of the thirteenth century. What changed here was the position of the healthy brethren. Just as before, they were to pray for, serve and care for the sick. But now, they were to also fight for the ‘defence of the Holy Cross’. We are clearly dealing here with healthy knights who were ready to fight:  from that perspective, they were to wear a coat of arms, and notably to be able to carry a shield. But whenever not on the battlefield, the Lazarite was to give his time to combating the suffering of the sick. The Rule tells us that he thus had responsibility for two beds in the convent: his own, and that of a sick person to whom he was to dedicate his time and energy. Just like the knights of Saint John, the knights of Saint Lazarus were to fight and to care for the sick at the same time, as two parallel activities. The Order of Saint Lazarus was thus defined in its Rule as a military and hospitaller Order. Its recognition as such, and its position vis-​à-​vis the other crusading Orders, has been discussed elsewhere.17 Yet, there remains an issue that has not been thoroughly considered in the history of the Order of Saint Lazarus. In most of the literature on the Order, there seems to be some kind of embarrassment when it comes to what could be called the myth of knights who had leprosy. Some researchers mention this subject,18 others even use it as the title of a book,19 but they generally fail to explain exactly what they mean. The Order of Saint Lazarus very much resembles the other crusader Orders, with the important exception of being composed of leprosy sufferers as well as healthy knights. This phenomenon requires greater attention, and we hope to shine a new light on this well-​known but somewhat overlooked aspect of the crusades. The quarter-​century from 1240 to 1265 is a particularly crucial period for understanding this issue, as it was a key moment in the evolution of the Order from the leprosarium into something new. A  close study of the source material, from documents to manuscript illustrations and the seals attached to charters, helps us

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to appreciate the way that this institution did, at times, play with the ambiguity of its identity. What words were used? Which images were deployed, directly or indirectly? How did these interact with commonly held ideas about leprosy? What did the notion of active crusading warfare add to the Order’s former identity?

The forgotten words from overseas Let us first consider the written sources. Around the middle of the thirteenth century, the Order of Saint Lazarus indeed reappears in texts. But it is not in documents dealing with welfare, as before. It is in the documentation that circulated in the West concerning the fighting taking place overseas. Echoes of these military engagements were widespread throughout the West through letters, chronicles and other descriptions copied and diffused among the ecclesiastical and lay communities. The first document that interests us is dated October 1244. The crusading army was then facing the Egyptians at La Forbie, a place located between Ascalon and Gaza. The Latin army was soon encircled, and thousands of crusaders were killed. A  letter sent back to the West by Robert, patriarch of Jerusalem (1240–​54), gives details: I, Robert, patriarch of Jerusalem, though unworthy, wish to tell all who are concerned by the Christian cause, that in the year of our Lord 1244, on the 15th kalends of October, which is the vigil of Saint Luke the Evangelist, wars and many other happenings affected us here in the Holy Land. The first destruction took place in August, when the city of Jerusalem was destroyed by the Chorosmins. The second destruction took place on the vigil of Saint Lucy in the plains of Gador, best known as ‘white sands’. From the house of the Temple, 312 brethren knights and 324 turcopoles were completely slaughtered. From the house of Saint John, 325 brethren knights and 200 turcopoles were also killed. From the House of the Germans, no one remains except three brethren, all the rest of the 400 from that house have died. From the house of Saint Lazarus, all the knights with leprosy have been killed.20

This letter, which survives as a copy entered by the Franciscan friar Salimbene di Adam (1221–​c. 1290)  into his Chronicle begun in

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around 1282, is very precise. It distinguishes between the military Orders and that of Saint Lazarus. Templars, Hospitallers and Teutonics are described as ‘brethren knights’. The knights of Saint Lazarus are labelled differently, as ‘knights with leprosy’. Does this mean that they were not religious brethren committed into their Order, or does it mean that their sickness was their defining characteristic? The next written references are clear. They date from February 1250. Louis IX, king of France, was then leading his army near Mansourah, in Egypt. The army needed to cross the river to begin besieging the city, but the king ordered the troops to wait on the other side of the river before attacking. Nonetheless, his brother, Robert d’Artois, went ahead and crossed, along with the knights of the military Orders, and they rushed into the town. The chronicle of Jean de Joinville (1224–​1317) tells us how they all became trapped at a dead end, and how the town’s inhabitants killed them all with arrows and rocks thrown from the rooftops. He cites the members of the three main military Orders (The Templars, the knights of Saint John (Hospitallers) and the Teutonic knights) among the victims.21 In his Chronica majora, compiled up to the year 1259, the English monk Matthew Paris also mentions the matter precisely, twice. But in each occurrence, he adds the name of the Order of Saint Lazarus. The first reference states: ‘The Templars and the Hospitallers, and the brethren of the Teutonic Order of Saint Mary and of the Order of Saint Lazarus, were twice taken prisoner, dispersed and put to death.’22 Further on, he writes: In this last year of the last half-​century, the Saracens triumphed at will, and unfortunately the whole Christian army, consisting of the nobility of all France, the Templars, the Hospitallers, the knights of the Teutonic order of Saint Mary, and those of Saint Lazarus, was cut to pieces in Egypt; and at the same time also, Louis, the pious king of the French, was taken prisoner, along with his two brothers, the counts of Poitou and Provence.23

Matthew Paris mentions the knights of Saint Lazarus alongside the brethren of the other military Orders, making no specific distinction. The final reference, another from de Joinville’s chronicle, is dated June 1253.24 The French armies had established themselves near Jaffa. One night, the alert was given that the master and brethren

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of Saint Lazarus, who had gone to collect some booty nearby, had been attacked by the Muslim forces. The crusaders rushed to save the last four Lazarite knights who were still alive. Unfortunately, de Joinville does not tell us how many knights of Saint Lazarus were involved in total. Whilst the king was encamped by Jaffa, the master of Saint Lazarus heard that at Ramah, three leagues away, there were some cattle and other things of which he might make a fine haul. So, since he held no rank in the army, and thus went as he liked, he went there without warning the king. As soon as he had collected his booty, the Saracens fell upon him and routed him so utterly that of all the men with him in his troop, only four managed to escape. As soon as he came back to the camp, he began to call for help. I went to arm myself and begged the king to allow me to go there. He gave me leave and ordered me to bring along the Templars and the Hospitallers. When we arrived, we learnt that other unknown Saracens had come down to the valley where the master of Saint Lazarus had been attacked. While these new Saracens were examining the dead bodies, the master of the king’s cross-​bowmen ran on them, and before we arrived, our people had routed them and slain several of them.25

These texts reveal a precise use of vocabulary. The letter of 1244 refers to the ‘leper knights’ of Saint Lazarus. The notion of knightly status in connection with the Order of Saint Lazarus disappears in Matthew Paris’s references; de Joinville’s 1253 description, though not mentioning leprosy, alludes to the fact that the Order of Saint Lazarus was separated from the rest of the army, holding no fixed rank in the military crusading organisation. Does that mean that the knights of Saint Lazarus were kept apart because of their sickness, perhaps reflecting concerns about contagion? Yet they died with the other troops: in Mansourah, evidently rushing into the town along with other contingents of the army. What was the precise identity and status of the military section of the Order of Saint Lazarus? And were these fighting Lazarite knights actually suffering from leprosy? Some forgotten words from overseas shed light on these questions. They relate to the letter mentioned above that tells of the defeat at La Forbie in 1244. This letter was copied many times in order to be diffused throughout Europe, and survives in various manuscripts. But two vital words are missing in most versions of the text. The sentence relevant to us usually reads: ‘All the knights

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with leprosy from the house of Saint Lazarus have also been killed.’ And the academic transcription tells us, through a small footnote, that two manuscripts add two words omitted by all the others, modifying the phrase ‘milites leprosi’ to ‘milites leprosi et sani’: a small, but very important detail.26 The ‘knights with leprosy’ hence become the ‘knights, leprous and healthy’ of Saint Lazarus. These additional words indicate that the troop of brethren of Saint Lazarus was composed of two parts, one healthy, and the other sick, apparently fighting alongside each other. New questions emerge. In what proportion did those two factions of the same order fight? Were there always knights with leprosy engaged in combat? And who actually were these knights with leprosy?

‘Leper knights’ We find only a few specific examples of knights suffering from leprosy in the Latin East. According to an Arab chronicle, Count Robert of Zerdana was captured in 1119 by the Muslims, who quickly executed him after discovering the sores covering his body under his armour.27 If these sores reflected leprosy, Count Robert had evidently continued governing his territory and fighting in battle in spite of his sickness. The best-​known case of this type is that of Baldwin IV, the ‘leper king’ of Jerusalem from 1174 to 1185.28 A  dynastic replacement was not possible for such an important position. Even the pope agreed on the fact that the disappearance of Baldwin from the political scene would have caused a disastrous factional crisis within the Latin kingdom. Baldwin managed to continue to govern, even leading on the battlefield, although he appeared on a stretcher when his strength grew weak towards the end of his life. Yet in 1174, in his encyclical Cor nostrum, Pope Alexander III accused King Baldwin IV and his illness of being physically, morally and figuratively responsible for the failure of the crusades.29 On the basis of the evidence concerning ‘leper knights’, some scholars have suggested that the Latin East during the crusades was a context in which leprosy sufferers benefited from an exceptional tolerance, allowing the sick not to withdraw from society but to remain a part of it.30 Yet if we look closely at other sources, we find

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that the so-​called integration of people with leprosy in the Latin East was limited only to certain cases. Like Baldwin IV, Count Robert of Zerdana’s feudal position may have not made it possible for him to give up his social and military role. In other contexts, leprosy sufferers were in fact set apart from society, even if they remained together as a group. For example, in 1160, Hugh I Grenier made a donation to the Jerusalem leprosarium with respect to his elder brother Eustache III Grenier, who by that time ‘dwel[t]‌among the leper community’.31 Eustace’s tenure of the lordship of Caesarea had by this point been ceded to Hugh:  his sickness had rendered him unable to govern. By the beginning of the thirteenth century, specific legislation was in place in the Crusader States concerning knights with leprosy. The Livre au Roi, the legal code for the kingdom of Jerusalem drawn up between 1196 and 1205, clearly states that all knights suffering from leprosy must retire from social life: Chapter 42. Here is the law to be respected if ever a knight liegeman becomes leprous, and here are the rules to apply for him and his fief as soon as the disease affects him, regarding where he must live and remain. If ever, by our Lord’s will, a liegeman becomes leprous, and nothing may cure the disease that has a hold on him, the law judges and orders that he must enter the Order of Saint Lazarus, where it is established that people with such a sickness should be. And if the law judges that, as long as he lives, he may have his fief administered by another knight or sergeant in his name, the fief is to be thus held, and the revenues of the fief should be delivered to him as long as he lives, in the place where he lives, and after his death, if he has no heir, the revenues should return to the lord from whom he held the fief. If the liegeman has a wife, reason and law judge that the marriage must be kept in being, but that they must not remain [living] together. Thus his wife is to enter the feminine Order of nuns, because if another man should unite physically with her, he may be touched by the disease, because she had intercourse with her husband after he caught the disease. This is why she must enter an Order like her husband.32

Knights with leprosy thus have to enter the Order of Saint Lazarus, for a life of seclusion. They may retain their social status and revenues, but have to have their affairs taken care of by a sergeant, until their death. If they are married, their wives also have to retire

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as nuns, in order to avoid any sexual intercourse, which may further spread the disease. This additional detail marks a rare instance of the existence of information about women affected by leprosy in the Latin East. Officially still alive, these knights of the Latin kingdom of Jerusalem could nonetheless no longer remain living in healthy society. The situation was similar within the other military Orders. In the regulations of these Orders, a knight who was diagnosed with leprosy could not remain with the other knights. By 1260, an additional chapter on this matter had been added to the Rule of the Templars: a Templar knight who was found to have leprosy was to leave the Order and join the brethren of Saint Lazarus: Chapter 443. If ever, by our Lord’s will, a brother should have leprosy, and the fact is proven, the master of the house should admonish him and entreat him to ask to leave the house and go to [the Order of] Saint Lazarus. And the sick brother, if he is a man of good will, should obey. It would even be a better thing if he asked for leave himself, before being admonished and entreated to. And if the brother asks to leave, the master, or whoever is dealing with the matter, must give him leave, in respect of the other brethren. Afterwards, the master of the house must keep on helping him after he has taken the habit of Saint Lazarus. They must pay careful attention to how he is accepted in [the Order of] Saint Lazarus, and provide what he humbly needs, as long as he lives.33

The Templars are to ensure that the knight with leprosy has all that he needs to live in the Order of Saint Lazarus. But he is no longer accepted among the other Templars, alongside the healthy knights. He is also to leave behind his official status. The Hospitaller Rule of 1270 similarly asserts that brethren with leprosy must not be allowed to wear the Hospitaller habit or live alongside the other brethren. Just as in the Templars’ Rule, they are to be fed and dressed elsewhere, ‘It is also established that, wherever brethren become leprous, they must not wear the habit [of the Order] as before, nor be seen among the other brethren. They are to be provided with food and clothing.’34 The Teutonic Rule specifies the same requirement:  brethren suffering from leprosy were ordered to give up fighting alongside the other knights, and to live apart from them.35 These legal documents

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clearly indicate a belief within the crusading society of the thirteenth century that leprosy sufferers should be segregated. For the Order of Saint Lazarus, we are no longer dealing with the management of a monastic community, as in the twelfth century: we are dealing with a context of anxiety about leprosy, perhaps with regard to contagion. But then, how must we understand the presence of those knights of Saint Lazarus with leprosy on the battlefield from 1244 to 1253? A few further pieces of information may explain the situation. It is well known that, by the thirteenth century, the Crusader States were regularly short of manpower for their fight to defend themselves against the Muslim forces. A  century after the First Crusade, during which thousands of men and women had crossed the sea to engage in worship and reconquer Jerusalem, the Latin kingdom in the East could hardly establish and maintain a regular army. There were regular calls to the West for reinforcements, only a few of which resulted in new passagia (crusading expeditions).36 Even though mercenaries were often employed to supplement the meagre Latin forces, the crusaders were often outnumbered on the battlefield. In such a situation, where a lack of manpower was a continuous problem, it is possible that knights with leprosy formed a part of the Frankish army. It was not a permanent situation: they were to hold no particular rank, to echo Jean de Joinville’s description. They obviously were not fully accepted, or considered equals, alongside their fellow combatants. They accompanied the rest of the army as a specific, unique section of the Christian force. These knights may thus have been tolerated, exceptionally, for a limited period of time. The slow gestation of leprosy may also explain the knights’ presence on the battlefield. The period of time between the diagnosis and the development of serious physical disability may extend to a few years or longer. Before that point, the sufferer may well still have been able to function relatively normally, and was thus potentially fit for military action37 –​not to mention the absence of a solid medical verdict before the fourteenth century: this caused men and women experiencing other sicknesses with symptoms similar to leprosy to be to be misdiagnosed.38 Last but not least, this active military involvement may also have been charged with the spiritual and eschatological beliefs linked

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to the crusades. Those beliefs, though not explicitly expressed in texts relating to the Order of Saint Lazarus, correspond with the situation and may help us understand it. We must remember that Jerusalem, during the twelfth century, was the place of Incarnation. Leprosy was the sign, the stigma sent by God to call his faithful to do penance.39 ‘Pre-​ sanctified’, as presented elsewhere in this 40 volume, people with leprosy were to suffer in his name, mortified near the place where Christ suffered also, in order to be redeemed in his bosom, just like their patron Lazarus. Condemned to death, they were never to leave, but were to remain close to Christ’s Sepulchre. As powerful intercessors, they were part of the messianic and eschatological expectations linked to the celestial Jerusalem.41 Most of them were, by then, pilgrims and crusaders from elsewhere, with no previous social link with the Latin kingdom.42 Hence, they were to be buried near the leprosarium, outside the door dedicated to Saint Stephen, in a common mass grave, whereas the local inhabitants of Jerusalem preferred more identifiable and individuated cemeteries.43 But by the thirteenth century, the scene had changed. Jerusalem was now lost, along with its former crusading symbols. Crusaders took the Cross to fight actively overseas in order to gain an eternal indulgence. The calls from the papacy were clearly aimed at sustaining a military force, not at bringing people across the sea to worship a sacred place. The context was different. Pilgrims were replaced by knights. Who were these? As the Livre au Roi presented it, we may be dealing with aristocratic knights, who left behind local feudal contexts in Europe because of the sickness. In contrast to pilgrims, these men were skilled in carrying arms long before leprosy affected them. And would not sick knights, already considered as God’s elect through their stigmatised sickness, have sought a most particular form of martyrdom? Instead of just dying of leprosy behind the walls of a leprosarium, they could expect to be called back to God, and potentially to die as active crusaders. Sword in hand against the Infidel, they may have sought an enhanced form of what Malcolm Barber calls a ‘new knighthood’ –​we might even say a new form of redemption, closely associating leprosy and crusading.44 The Holy Land has been considered an experimental space for the institutional form

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of the hospital; this experimentation was extended to a unique relationship between sickness and warfare.45 The idea of knights surpassing their incurable sickness in a last fight in the name of the Cross seems quite stunning to the modern viewpoint. It has nuances concerning the traditional tripartite division of society: here, the sick may pray, of course, but also fight. Jacques de Vitry placed leprosy sufferers in a separate category of their own:  just below members of the military Orders, but first among all the various groups of the laity.46 In the Order of Saint Lazarus, they were actually incorporated into a military Order, thus taking one step further from the terrestrial to the celestial scale. However, this situation did not last for long. Because of an evident lack of recruitment, and because of the imperatives of the military situation of the Latin kingdom of Jerusalem, the Order of Saint Lazarus had to evolve again quickly.

The petition for change A petition sent to Pope Innocent IV by 1253 sheds a different light on the importance of leprosy within the Order.47 The state of affairs demonstrated marks a third stage in the Order’s evolution. This petition, written by the Lazarite brethren, presents the fact that the hospitaller community had always followed the tradition of electing one of the leprosy sufferers as its master, a practice that may also be found in some European leprosaria, as discussed elsewhere in this volume.48 But the brethren report that recently, all of the sick knights have been killed while fighting for the faith. They therefore ask permission to choose their master from among the healthy knights of the Order: To the bishop of Tusculanum, legate of the Apostolic See, as our dear sons the master and brethren of the house of Saint Lazarus of Jerusalem point out in a petition, in their house, there has for a long time been the approved habit of naming a knight with leprosy, among the brethren of that house, as master. Yet since all the knights with leprosy of the said house have been miserably killed by the enemies of the Faith, it has become impossible to observe that custom. Since permission has been humbly asked to elect the master from the healthy knights among the brethren of the house, notwithstanding

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the custom, we wish to concede such permission. Hence we ask you to approve this with our authority and your full circumspection in the Lord, as you see fit according to God. Given in Perugia, XV kalends of February, tenth year [of our episcopate].49

Crucially, this statement confirms that knights with leprosy were indeed going to battle, at least up to 1253. Yet they may not have been numerous. By 1250, the Latin kingdom of Jerusalem had already lost an important part of its former territorial importance: it was then limited to a few possessions along the coast. Its population had diminished drastically since the golden age of Latin colonisation.50 After the sick brethren of Saint Lazarus had been killed in battle, there were apparently no other leprous knights to replace them or to fill the office of master of the Order. The Order thus needed to be sustained by its healthy members. Pope Alexander IV and his successors in the decade between 1255 and 1265 progressively managed to suppress the military role of the sick in the Order of Saint Lazarus. It is indeed striking how papal diplomacy from then onwards used different, more normative words. Up to 1255, papal bulls and donations were issued to the ‘hospital’ of Saint Lazarus. Texts were then still addressed to a ‘community of knights, healthy and sick, both fighting against the enemies of the Christian name’, acknowledging the double composition of the military involvement of the order.51 But from then on, the word militia, focusing on a military function, increasingly became the word most frequently associated with the Order, up until the loss of Acre in 1291.52 As an example: by 1256, donations in England in favour of the Lazarites were officially encouraged by the king no longer in order to sustain leprosy sufferers, but rather so that ‘horses, men and equipment’ could be sent from the port of Dover to the Latin East.53 All donations and support from then on were to benefit the healthy knights who, though still caring for the sick, were fighting in the name of the Cross overseas. The final chapter of the rule of the Lazarites, drawn up by 1265, confirms this new emphasis by adding a new prescription:  when drawing up further regulations, the brethren were to be inspired by the rules of the Templars or the Hospitallers.54 The Order thus shifted decisively towards the model of the Hospitallers of Saint John of Jerusalem, who were mainly healthy knights who cared for

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the sick, not sick knights themselves. The Order of Saint Lazarus was thus redefined as a conventional military order, the healthy knights of which went to battle. The sick members of the Order obviously remained behind, cared for within the walls of their last convent, at Acre. A final source confirms the shift of identity of the knights of Saint Lazarus. In the annals of his Chronica majora, Matthew Paris recounted the itinerary of the pilgrimage from London to Jerusalem.55 This itinerary includes a depiction of Acre, by this point the capital city of the Latin kingdom of the East. Two manuscripts contain detailed images of the buildings sheltering each crusading Order installed within the city’s walls. The seat of the canons of Saint Thomas is represented as a church with columns and a tower. The hospital of Saint John is shown as a structure flanked by two towers and with what seems to be a dungeon in the middle. The house of the Templars is a huge dome situated by the sea. The monastery of the Lazarites is located in the quarter of Montmusard. In the first manuscript, the monastery is represented as a round tower facing the sea, with battlements on top. The legend reads ‘Domus militum Sancti Lazari’ (‘the house of the knights of Saint Lazarus’).56 There is no figurative allusion to the hospital function of the building:  rather, the words and the image only allude to a military and defensive function. In the second manuscript, the image is presented differently. The battlements have disappeared, and a roof protects the building from the heavens above. The legend now reads: ‘Dom[us] militu[m]‌ecc[lesi]e s[anc]ti Lazari q[ui] s[un] t i[n] bellu[m] p[er]ambuli’ (‘the house of the knights of the church of Saint Lazarus, who are engaged in war’).57 Some have argued that Matthew Paris, drawing in England, far from the battlefields in the East, must not be considered as a reliable source.58 Yet the English monk may have sought to represent the new identity of the Lazarites, which was by then diffused far overseas, as a clarification to an audience that may have assumed that, because of their sickness, these knights would not have fought on the battlefield. A different picture of the Order was indeed diffused back to Europe. By that time the Lazarites were permitted to raise alms, as well as to sell indulgences, in the same way as other representatives of the crusading cause. They managed to obtain grants of lands

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and domains in different realms, just like the other active crusading militia.59 There were to be no more references to knights with leprosy. Their prominence on the battlefield was brief, lasting less than a decade (from 1244 to 1253). Leprosy’s progressive shift of identity in the Order up to this time, from penitential pilgrimage to active knighthood, was nevertheless unique. If we have been able to follow it here mainly through words, let us now consider it further through the images of the period.

Sealed identities As well as manuscript illustrations, another aspect of visual culture, namely the iconography of seals, is very revealing. Seals were attached to charters, and display in an official manner the identities of individuals, families and religious communities. All the seals used by the Order of Saint Lazarus of Jerusalem bear revealing images. The evolution of these images from the end of the twelfth to the thirteenth century is significant. The first extant seal discussed here (Figure 10.1) is unfortunately not dated: torn apart from the document to which it was originally attached, it is now in a private

Figure 10.1  Nineteenth-​century drawing of a seal of the Order of Saint Lazarus, c. 1130–​87, showing a leprosy sufferer on one side and a bishop on the other.

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collection. Up to now, academic research has agreed to date it back to the period when the Order consisted of the hospital community in Jerusalem, approximately between 1130 and 1187.60 On one side is a representation of a leprosy sufferer. We see a man wearing a hood over his head, and covered with a cloak. The loose cloak is open on his chest, as an obvious indicator of poverty. He is showing a clapper in his raised right hand, an attribute of leprosy that would have been easily recognisable to many contemporaries.61 But on his face are also bodily signs of the sickness. Those may very well indicate the nodules covering his head and body, from the sight of which the hood and cloak are supposed to protect us. Both these are visual indicators of leprosy. The man brandishes the clapper upwards in an attempt to stir compassion. His other hand is open in front of his chest, as if calling out for all to see what symbolises his infirmity. But there is something more. Aside from hiding the nodules on his head, the hood may also allude to the man’s religious status. This image underscores the fact that, in Jerusalem, the sick form a religious confraternity, an Order based on the charitable care, if not medical cure, of leprosy sufferers. The sick man is thus depicted as a sort of monk, which indeed he was: let us recall that the first statutes of that time order the brethren of Saint Lazarus to make the three vows of poverty, chastity and obedience, and to live daily from then on in accordance with the liturgical activities of this hospitaller monastery.62 Leprosy is here presented as a characteristic aspect of the religious communities of Latin Jerusalem. We find confirmation of this message on the other side of the same seal, where a bishop is depicted. He is wearing a mitre on his head, the proper liturgical headdress for all bishops of the Latin rite. His chest is covered by a chasuble. He holds a crozier in his left hand, while making a blessing sign with the right one. Many monastic houses included bishops and archbishops on their seals to represent their communities as members of the ecclesiastical hierarchy.63 This side of the seal may thus reflect the wish of the nascent Order to be recognised among the religious communities in the Latin East. If some scholars have identified this figure as the patriarch of Jerusalem,64 I wish to consider here the possibility that he could in

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fact be a representation of Saint Lazarus. In some legends the saint was believed to have become, after coming back to life, bishop of Marseille. His use in the symbolism of leprosy communities was quite current at this time.65 Although the bishop figure on the seal is not explicitly labelled as Lazarus, it is likely that this is the figure’s intended identity. Another seal used by the Lazarites does indeed name him as such. This seal (Figure 10.2) dates from about a century later, in 1287. By then, like all the other military Orders, the Lazarites had managed to expand their presence in Europe: through grants and donations, they had set up a small network of preceptories aimed at gathering incomes for the crusading cause in the East.66 The seal was used by the official representatives of the Order, and its iconography directly

Figure 10.2  Nineteenth-​century drawing of a seal of the Order of Saint Lazarus dating to 1287 and showing a seated bishop with the legend ‘EPISCOPVS LAZARVS’.

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appeals to the expectations of western European viewers. Here the bishop is wearing his dress, again covered by a chasuble. His is also wearing a mitre on his head. But this time, he is seated on a sort of chair or throne. In his right hand, he holds the crozier, while in the left one, he shows us what seems to be a book. The legend spreading around him on the corner of the seal reads ‘EPISCOPVS LAZARVS’ (Bishop Lazarus).67 Lazarus is here clearly presented as a bishop, underlining the Order’s wish to be associated both with the ecclesiastical hierarchy and with this particular saint, himself closely connected to leprosy sufferers. The book held by the saint may also be a reference to the liturgical activities of the community. This seal, unlike that of the twelfth century, has no imagery of sickness. The designation of the saint-​bishop apparently suffices for the identification of leprosy, and the religious identity of the Order is the aspect most heavily emphasised. By the middle of the thirteenth century, when the Order of Saint Lazarus was also recognised as a crusading military faction, its seals start to show a new feature:  a cross. This was the most popular, common sign for crusading, found many times in manuscript illustrations, and on clothing and weapons. Most of the military Orders used it on their coats of arms, each one with a different colour, in order to be identifiable on the battlefield. According to the additional Rule of the Order of Saint Lazarus, drawn up during the second half of the thirteenth century, the cross to be figured on the coat of arms of the Order was to be green, and also featured on the shields carried by the Lazarite knights.68 We find this image on a seal of the Order used in Germany by 1282 (Figure 10.3).69 The new military, crusading identity of the Order was thus also represented on seals. In a final stage, the Lazarite seals commuted all three references into one. On a seal dating from 1289 (Figure  10.4), we find the bishop again, easily recognisable through his clothing and mitre.70 This time he is standing up, giving a blessing with his right hand and holding the crozier with his left hand. But his chasuble is covered with something new. There seems to be a crusader cross on his chest. He still has no clapper, but is shown as a crucesignatus (a person signed with the cross). Saint Lazarus, in the form of the bishop, is now the one taking the crusading vow, as if he was willing

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Figure 10.3  Nineteenth-​century drawing of a seal of the Order of Saint Lazarus used in Germany by 1282 and showing a cross.

to engage himself in the recovery of the Holy Land. The message is clear: sustaining the Order of Saint Lazarus is a way to reinforce the crusading cause. Yet the disease is still fundamental to the Order’s identity, featured through its patron. All aspects of the identity of the Order, be it an emphasis on assisting leprosy sufferers or on recovering the Holy City, here merge into one. Assisting the sick is presented, through the holy figure, as the broader background to the military engagement to save the Holy Land. This seal combines the ideal of fighting for the cross, and potentially dying as a martyr in the Holy Land, with the religious engagement of prayer and penance while waiting for death and hoping for the afterlife, as symbolised by Lazarus. The image on the seal of 1289 depicts the amalgamation of associations that made the Order of Saint Lazarus a different crusading order from its counterparts.

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Figure 10.4  Nineteenth-​century drawing of a seal of the Order of Saint Lazarus dating to 1289 and showing a bishop wearing a cross on his chest.

Images like these were very important in a society that was far from being fully literate. Seals were still used as a means of expression by the Lazarites long after the end of the crusades; up to modern times, the clapper, the bishop and the cross have been presented by the Order in order to express, when necessary, an adapted notion of leprosy.71 In the period in question here, the imagery was progressively distorted, in order to fit with society’s expectations. In Chapter 8 of this volume Luke Demaitre evokes the evolution of the representation of the leprosy sufferer from prostrate pauper to able-​bodied Lazarus. We find here a full illustration of this process, yet going one step further with the addition of the notion of crusading. While we must always remain aware of the

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potential disparity between idealised images and everyday reality, differentiated levels of identification for the disease are nonetheless visually conveyed in these seals.

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Conclusion The case of the leprosy sufferers and, later on, the knights with leprosy from the Latin kingdom of Jerusalem clearly illustrates how ideas, attitudes and practices relating to leprosy varied both geographically and over time. Leprosaria in the West never had the unique religious significance of those in Jerusalem. No sick intercessors were as close to the Holy Sepulchre as those of the Order of Saint Lazarus. Knights with leprosy are not found anywhere other than in the Latin East. The Order enabled leprosy sufferers to form a specific community, and to share common, innovative identities. But it is not as if in the Latin kingdom of Jerusalem leprosy sufferers were able to remain in society, thus experiencing an exceptional degree of toleration.72 The laws and statutes concerning leprosy were strict. Just as elsewhere, as noted in more than one chapter in this book, during the thirteenth century the fear of contagion increased. In the Latin East people with leprosy were to remain physically apart from others. Yet they managed to retain a degree of inclusion and integration as a result of a unique religious and military situation, being tolerated on the battlefield in order to sustain a fragile Christian army.73 The experiment of ‘leper knights’ on the battlefield lasted only a little more than a decade. The leprosy sufferers installed in Acre by 1240 had less of a spiritual aura than those who had lived in the sacred city of Jerusalem, and thus attracted less support. Furthermore, the knights with leprosy, because of their disease, could not sustain a permanent and operational presence to defend the last bastions of the Holy Land. Hence the Order of Saint Lazarus became like the other military and hospitaller Orders, with healthy knights caring for the sick. This enabled the Order to maintain a more stable and recognised position in the crusading network, while also continuing to adapt to a perpetually changing environment

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and to changing perceptions. Overall, as demonstrated by written and material evidence, leprosy was integral to the development of the Order’s identity.

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Notes 1 D. Marcombe, Leper Knights (Woodbridge:  Boydell Press, 2003). R. Hyacinthe, L’Ordre de Saint-​Lazare de Jérusalem au Moyen Age (Millau: CLTH, 2003). 2 F.-​ O. Touati, ‘De prima origine Sancti Lazari Hierosolymitani’, in D. Coulon, C. Otten-​ Froux and P. Pagès (eds), Chemins d’outre-​ mer:  Etudes d’histoire sur la Méditerranée médiévale offertes à Michel Balard (Paris: Publications de la Sorbonne, 2004), Vol. II, pp. 801–​12; F.-​O. Touati, ‘La Terre sainte: Un laboratoire hospitalier au Moyen Age?’, in N. Bulst and K. H. Spiess (eds), Sozialgeschichte mittelalterlicher Hospitäler (Otsfildern:  J. Thorbecke, 2007), pp. 169–​211. 3 C. de Marsy (ed.), ‘Fragment d’un cartulaire de l’ordre de Saint-​Lazare en Terre sainte’, Archives de l’Orient Latin, 2 (1884), 149–​56. 4 Demaitre, Leprosy, pp. 80–​1. 5 R. Hyacinthe, ‘Lazare et les autres: Pistes de recherche sur les dédicaces et les cultes hagiographiques dans les léproseries médiévales’, Revue de la société française d’histoire des hôpitaux, 152 (2014), 7–​16. 6 See F.-​O. Touati, Chapter 2 in this volume, pp. 57–​8. 7 F. Bériac, Histoire des lépreux au Moyen Age:  Une société d’exclus (Paris: Imago, 1988); N. Bériou and F.-​O. Touati (eds), Voluntate Dei leprosus:  Les lépreux entre conversion et exclusion aux XIIème et XIIIème siècles, Testi, Studi, Strumenti, 4 (Spoleto: Centro italiano di studi sull’Alto medioevo, 1991). 8 R. Hyacinthe, ‘Living for the dead of Jerusalem:  Medical isolation and holy deeds in the leprosarium of Jerusalem during the crusades’, in C. Bonfield, J. Reinarz and T. Huguet-​Termes (eds), Hospitals and Communities, 1100–​1960 (Oxford: Peter Lang, 2013), pp. 75–​95. 9 R. Hyacinthe, ‘L’Ordre de Saint-​Lazare de Jérusalem dans le contexte spirituel des croisades: Une réévaluation’, in A. Luttrell and F. Tommasi (eds), Religiones militares: Contributi alla storia degli ordini religioso-​ militari nel medioevo (Castello: Selecta, 2008), pp. 43–​59. 10 C. Maier, Preaching the Crusades (Cambridge: Cambridge University Press, 1994); P. J. Cole, The Preaching of the Crusades to the Holy Land (1095–​1270) (Cambridge: Cambridge University Press, 1991).

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11 A. Forey, ‘The militarisation of the hospital of Saint John’, Studia monastica, 26 (1984), 75–​89. 12 A. Forey, ‘The Military Order of Saint Thomas of Acre’, English Historical Review, 92 (1977), 481–​503. 13 De Marsy, ‘Fragment d’un cartulaire’. 14 On the organisation of hospitals and leprosaria in medieval Europe as Augustinian communities, see F.-​O. Touati, ‘ “Aime et fais ce que tu veux”:  Les chanoines réguliers et la révolution de charité au Moyen Age’, in M. Parisse (ed.), Les chanoines réguliers:  Emergence et expansion (XIe–​XIIIe siècles); actes du sixième colloque international du CERCOR, Le Puy en Velay, 29 juin–​ 1er juillet 2006 (Saint-​ Etienne:  Publications de l’université de Saint-​ Etienne, 2009), pp. 159–​210. 15 Hyacinthe, ‘L’Ordre de Saint-​Lazare’, pp. 44–​6. 16 P. G. Morel (ed.), ‘Die ältesten Statuten für die Lazaritenklöster Seedorf, im Gfenn und in Slatte’, Der Geschichtsfreund:  Mittheilungen des historischen Vereins der fünf Orte, Lucern, Uri, Schwyz, Unterwalden und Zug, 4 (1857), 145–​54; K. P. Jankrift, Leprose als Streiter Gottes (Münster: LIT, 1996). 17 R. Hyacinthe, ‘De domo Sancti Lazari milites leprosi: Knighthood and leprosy in the Holy Land’, in B. Bowers (ed.), The Medieval Hospital and Medical Practice (Aldershot: Ashgate, 2007), pp. 209–​24. 18 M. Barber, ‘The Order of Saint Lazarus and the crusades’, Catholical Historical Review, 80 (1994), 439–​56; A. Demurger, Chevaliers du Christ:  Les ordres religieux-​ militaires au Moyen Age (Paris:  Seuil, 2001), pp. 43–​5; Bériac, Histoire des lépreux, pp. 233–​4. 19 Marcombe, Leper Knights. 20 ‘Ego Robertus patriarcha de Ierusalem, licet indignus, notum facio cunctis qui Christiano censentur nomine, quod in anno Domini MCCXLIIII, XV kal. Octobris, hoc est in vigilia Sancti Luche evangeliste, facta fuerunt bella et traditiones multe apud nos, hoc est videlicet in Terra Sancta. Prima destructio que facta fuit in Augusto, quando civitas Ierusalem destructa fuit a Colosininis. Secundo destructio que facta fuit in vigilia Sancte Lucie in planicie de Gador, hoc est ‘sabulo albo’, quando de domo Templi fuerunt CCCXII fratres milites et CCCXXIIII turropli penitus occisi. De domo sancti Iohannis CCCXXV fratres milites et CC turropli similiter occisi sunt. De domo Alamannorum non remanserunt nisi tres fratres, alii omnes occisi sunt, videlicet CCCC de eadem domo. De domo sancti Laçari milites leprosis omnes fuerunt occisi.’ ‘Cronica fratris Salimbene de Adam’, Monumenta Germaniae historica:  Scriptores (Hanover:  A.  Hiersemann, 1905), Vol. XXXII, p. 177.

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21 Jean de Joinville, Histoire de Saint-​Louis (Paris: Jules Renouard, 1868), pp.  107–​9. 22 ‘Capti sunt, occisi et dissipati conventus Templi, Hospitalis, Sanctae Mariae Theutonicorum et Sancti Lazari, bis’. H. R. Luard (ed.), Matthew Paris: Chronica majora (London: Longman, 1880), Vol. V, p. 192. 23 ‘Sarracenis hoc ultimo hujus quadragenue annorum ad votum triumphantibus, totus Christianorum exercitus, proh dolor, trucidatur in Egipto, ex omni Franciae, Templi, Hospitalis, Sanctae Mariae Theutonicorum et Sancti Lazari, constans nobilitate; ubi etiam captus est cum duobus fratribus Pictaviae et Provinciae comitibus, pius Francorum rex Ludowicus’. Ibid., p. 196. 24 De Joinville, Histoire de Saint-​Louis, p. 193. 25 ‘CIV. Tandis que li roys estoit en l’ost devant Jaffe, li maistres de Saint-​Ladre ot espié delez Rames, à trois grans lieues, bestes et autres choses, là où il cuidoit faire un grant gaaing. Et il, qui ne tenoit nul conroy en l’ost, ainçois fesoit sa volentei en l’ost, sanz parler au roy ala là. Quant il ot aqueillie sa praie, li Sarrazin li coururent sus et le desconfirent en tel manière, que de toute sa gent que il avoit avec li en sa bataille, il n’en eschappa que quatre. Sitost comme il entra en l’ost, il commença à crier aux armes. Je m’alai armer, et priai au roy que il me lessast aller là, et il m’en donna congié, et me commanda que je menasse avec moy le Temple et l’Ospital. Quand nous venimes là, nous trouvames que autre Sarrazin estrange estoient embatu en la vallée où li maistres de Saint-​Ladre avoit estei desconfiz. Ainsi comme cist Sarrazin estrange regardoient ces mors, li maistres des arbalestriers le roy lour courut sus; et avant que nous venissiens là, nostre gent les orent desconfiz et plusiours en occirent.’ J. de Joinville and G. de Villardouin, Chronicles of the Crusades, ed. M. Shaw (London: Penguin, 1974), p. 300. 26 ‘Cronica fratris Salimbene de Adam’, p. 177. 27 K. Ed-​Dîn, ‘Extraits de la chronique d’Alep’, in Recueil des historiens des croisades:  Historiens orientaux (Paris:  Imprimerie nationale, 1884), Vol. III, pp. 621–​2. 28 B. Hamilton, The Leper King and His Heirs:  Baldwin IV and the Crusader Kingdom of Jerusalem (Cambridge:  Cambridge University Press, 2000), including Appendix B:  P. D.  Mitchell, ‘An evaluation of the leprosy of King Baldwin IV of Jerusalem in the context of the mediaeval world’, pp. 245–​58. 29 M. G. Pegg, ‘Le corps et l’autorité: La lèpre de Baudouin IV’, Annales ESC, 2 (March–​April 1990), 265–​87.

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30 P. Mitchell, Medicine in the Crusades (Cambridge:  Cambridge University Press, 2004), p. 106. S. Shahar, ‘Des lépreux pas comme les autres’, Revue historique, 267 (1982), pp. 19–​41. 31 De Marsy, ‘Fragment d’un cartulaire’, pp. 135–​6. 32 ‘Chapitre XLII. Ici orrés quell dreit on deit faire de celuy chevalier home lige qui deviant mesiau, et quell dreit a yl puis en son fié despuis que ce mau li avint, et où il det ester et maner. S’il avient que par la volenté de nostre Seignor un home lige devient mesel, si que mais ne puisse garir de sele meselerie qui fort s’est prise sur luy, le dreit juge et coumande que il deit estre rendue en l’ordre de saint Lasre, là où est estably que les gens de tel maladie deivent estre; et si juge la raison que tant come il vivra, si peut faire deservir son fié par un autre chevaler en son leuc ou par un sergent, se le fié est de sergent; et le remanant des biens de son fié det il aver tant come il vivra là où il est rendus; et après sa mort, s’il n’a nul heir, si torne tout au seignor de par qui il teneet celuy fié. Mais se celuy home lige avoit feme, la raison et le dreit juge que celui mariages det estre partis, si que mais ne devent estre ensemble, ains det estre sa moillet rendue en l’ordre des femes nounains, por ce que ce autres homes touchassent à luy charnelment, si porreent estre mahaignés de cele maladie, puis que elle a esté charnaument o ces maris despuis qu’il ot cele maladie; et por ce det estre en ordre auci come ses maris.’ A. A. Beugnot (ed.), ‘Le Livre au Roi’, in Recueil des historiens des croisades: Lois (Paris: Imprimerie nationale, 1841), Vol. II, pp. 636–​7. 33 ‘443. Quant il avient a aucun frere que par volonté de nostre Seignor il chiet en meselerie et la chose est provée, li prodome frere de la maison le doivent amonester et prier que il demande congié de la maison et que il se rende a saint Ladre: et le frere malade se il est home de bien lor en doit obeir, et encores lor seroit plus bele chose que il requist ledit congié par sei meismes devant que l’on l’eust amonesté ne prié. Et se le frere requiert ledit congié, le Maistre ou celui a qui il affiert li doit doner ledit congié, mès il le doit faire esgard des freres; et après, le Maistre et li prodome de la maison li doivent porchacier et aidier com li abit de saint Ladre li soit donés. Et se doivent prendre garde estudiousement que tel nostre frere, que en tel manière sera rendus a saint Ladre, n’i ait grant mesaie de les choses qui li soient mestier a sa povre soustenance tant come il vivra.’ H. de Curzon (ed.), La règle du temple (Paris: J. Renouart, 1886), pp. 239–​40. 34 ‘Item establi est que, se en aucune terre a frere mesel, que il ne doie porter l’abit deu qui en avant, ne qu’il ne voise entre les freres, et que l’en le doie porveyr de viandes et de vestir.’ J. Delaville Le Roulx

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(ed.), Cartulaire général de l’Ordre des Hospitaliers de Saint-​Jean de Jérusalem (Paris: Ernest Leroux, 1899), Vol. III, p. 229. 35 I. Sterns, ‘Care of the sick brothers by the crusader orders in the Holy Land’, Bulletin of the History of Medicine, 57 (1983), 43–​69. 36 C. Marshall, Warfare in the Latin East (1192–​ 1291) (Cambridge: Cambridge University Press, 1992). 37 See C. Roberts, Chapter 1 in this volume (pp. 36–​7). 38 Demaitre, Leprosy, pp. 197–​8. 39 It is no coincidence that the Livre au Roi and the Templars’ Rule, discussed above, use the formulaic phrase ‘by the will of our Lord’ when describing the affliction of leprosy, a phrase used in many documents produced in Europe at this time. 40 See Touati, Chapter 2 in this volume. 41 Hyacinthe, ‘Living for the dead of Jerusalem’. 42 R. Hyacinthe, ‘Crusaders, patients and brethren of Saint Lazarus of Jerusalem: Another perception of exile in the Holy Land’, unpublished paper presented at the International Medieval Congress, University of Leeds, 2002. 43 C. Rouxpetel, ‘Mourir à Jérusalem:  Ensevelir les morts, latiniser la Terre sainte’, in Société des historiens médiévistes de l’Enseignement supérieur public (ed.), Les vivants et les morts dans les sociétés médiévales (Paris: Editions de la Sorbonne, 2018), pp. 309–​22. 44 M. Barber, A New Knighthood (Cambridge:  Cambridge University Press, 1994). 45 Touati, ‘La Terre sainte’; Mitchell, Medicine in the Crusades. 46 See C. Rawcliffe, Chapter 4 in this volume (p. 96). 47 E. Berger (ed.), Registres d’Innocent IV (Paris:  Ecole française de Rome, 1897), Vol. III, p. 153. 48 See A. M. Peterson, Chapter 11 in this volume. 49 ‘Episcopo Tusculano, apostolice sedis legato, sua nobis dilecti filii magister et fratres domus Sancti Lazari Jerosolimitani petitione monstrarunt quod in domo ipsa, de antiqua et approbata et hactenus pacifice observata consuetudine, est obtentum ut miles leprosus, frater ipsius domus, in magistrum assumatur ejusdem. Verum quia fere omnes milites leprosi dicte domus fuerunt ab inimicis fidei miserabiliter interfecti, hujusmodi consuetudo nequit comode observari. Quare fuit nobis humiliter supplicatum ut eligendi de cetero aliquem militem sanum ex fratribus predicte domus in magistrum ipsius, non obstante consuetudine hujusmodi, sibi licentiam concedere curaremus. Nos itaque, de circumspectione tua gerentes in Domino fiduciam pleniorem, mandamus quatinus super hoc facias auctoritate nostra, quod secundum Deum videris expedire. Datum Perusii, XV Kalenas

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Februarii, anno X.’ Archivio Segreto Vaticano, Registro Vaticano XXII, fo. 230. 50 J. Prawer, ‘Colonization activities in the Latin Kingdom of Jerusalem’, Revue belge de philologie et d’histoire, 29(4) (1951), 1063–​118. 51 C. Cocquelines (ed.), Bullarum privilegiorum ac diplomatum Romanorum Pontificum:  Amplissima collectio (Rome:  F. Gaude, 1739), Vol. IV, Part II, p. 216; C. Bourel de la Roncière (ed.), Registres d’Alexandre IV (Paris: Fontemoing, 1902), Vol. I, p. 107. 52 Hyacinthe, L’Ordre de Saint-​Lazare, pp. 44–​6. 53 ‘Pro fratre Milone. Mandatum est baronibus et ballivis regis Dovor’ quod fratrem Milonem, magistrum generalem milicie Sancti Lazari Jerusalem, et magistrum Willelmum de Hereford, cum fratribus, hominibus, equis et hernesio suo, in portu Dovor’ libere transfretare permittant. Teste rege ut supra.’ in Calendar of Close Rolls:  1254–​ 1256 (London:  Her Majesty’s Stationery Office, 1892), p.  419; also 1259 (London:  His Majesty’s see Calendar of Close Rolls:  1256–​ Stationery Office, 1932), p. 130. 54 Morel, ‘Die ältesten Statuten’, pp. 144–​5. 55 S. Lewis, The Art of Matthew Paris in the ‘Chronica majora’ (Cambridge: Scholar Press, 1978), pp. 350, 360. 56 Cambridge, Corpus Christi College, MS 26, fo. IIIv. 57 London, BL, MS Royal 14 C VII, fo. 4v. 58 F.-​O. Touati, Actes et cartulaire de Saint-​Lazare de Jérusalem: 1124?–​ 1291 (unpublished habilitation à diriger les recherches, Université Paris I, 2001). 59 Hyacinthe, L’Ordre de Saint-​Lazare, pp. 47–​74. 60 C. S. Clermont Ganneau, ‘Un sceau des croisades appartenant à la léproserie de Saint-​ Lazare de Jérusalem’, Recueil d’archéologie orientale, 4 (1901), 242–​6. 61 See L. Demaitre, Chapter 8 in this volume (pp. 220–​3). 62 See discussion above, pp. 295–​7. 63 P. Harvey and A.  McGuinness, A Guide to British Medieval Seals:  London (London:  British Library and Public Record Office, 1996). 64 See Clerment Ganneau, ‘Un sceau’. 65 See Hyacinthe, ‘Lazare et les autres’. 66 Hyacinthe, L’Ordre de Saint-​Lazare, pp. 82–​5. 67 A. Nuscheler, ‘Die Lazariterhäuser im Gfenn bei Dübendorf und Schlatt’, Mittheilungen der antiquarischen Gesellschaft in Zürich, 9 (1856), Plate 2. 68 Morel, ‘Die ältesten Statuten’, pp. 142–​3. 69 Nuscheler, ‘Die Lazariterhäuser’, Plate 2.

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70 Ibid. 71 Hyacinthe, L’Ordre de Saint-​Lazare, pp. 139–​47. 72 Mitchell, ‘An evaluation of the leprosy of King Baldwin IV of Jerusalem’. 73 See L.  Barnhouse, Chapter  7 in this volume (p.  187) on the semi-​ integration of leprosy sufferers.

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11 Connotation and denotation: the construction of the leper in Narbonne and Siena before the plague Anna M. Peterson The aim of this volume, in part, is to discuss what the word ‘leper’ meant to the sick and healthy alike of medieval Europe.1 On the surface, a leper was simply a person who suffered from leprosy. However, this is only part of who a leper was and what they represented in medieval society. As the contributions to this volume show, the connotation and conceptualisation of the word ‘leper’ varied in different regions and contexts. The leper was to a great extent defined by his or her disease; however, the term ‘leper’ itself had a multifaceted connotation. Specifically, this chapter is focused on how the word ‘leper’ was employed in the documentation for Narbonne and Siena and what this tells us about local attitudes towards these individuals. The chapter examines the word ‘leper’, and all its derivatives in Latin and the vernacular, specifically Occitan in Narbonne (Languedoc) and Italian in Siena (Tuscany), before the Black Death in 1348. The analysis concludes in 1348 because it marks a point of significant demographic, social and political upheaval for both of these cities. Lepers were seen as either ‘tame’ or ‘wild’, a characterisation that coloured how they were perceived by medieval society. Narbonne and Siena offer a compelling comparison, especially with regard to the treatment and perception of lepers. These cities are in regions that are understudied vis-​à-​vis leprosy, and illustrate the varied approach to integrating or segregating leprosi. I argue that in the context of these two cities, ‘leper’ had a distinctive meaning, one that denoted a leprous person who conformed to a specific lifestyle as prescribed by local norms.

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Narbonne and Siena and their leprosaria The political history of these two cities makes them useful comparators. Both developed strong municipal authorities during the first half of the thirteenth century. In Narbonne, we see the emergence of a representative body for each half of the city:  the Consuls of the Cité and the Bourg respectively. Previously, Narbonne had been controlled by the viscount and the archbishop, who maintained a foothold in the city, albeit one that diminished over time. Steadily, from the mid-​thirteenth century to the fourteenth century, the kings of France worked to consolidate their royal power over the region.2 The Consuls unified in 1338. The union marked the apogee of the Consuls’ authority, since thereafter royal agents gained more ground in Narbonne under the seneschalsy of Carcassonne-​Béziers.3 In Siena, the Commune arose around the same time as the Consuls. Between 1200 and 1235 Siena was governed by either the consuls, or the podestà, a position filled by a Sienese citizen until 1212, when it was mandated that the podestà be a foreigner.4 In 1262 the Twenty-​Four Priors (1236–​71) developed the city’s first extant Constituto. This set an important precedent regarding the governance of the Commune, and its maintenance and alteration were passed on to their successors:  the Thirty-​Six (1271–​79), the Fifteen (1280–​87) and finally the Nine (1287–​1355).5 Narbonne and Siena each had two leper houses, all of which were situated outside the city walls and along major thoroughfares. In Narbonne, the leprosarium of the Cité was founded after 1090, and the house in the Bourg was established in 1106. Unlike the cases from Siena, the dedications for the houses in Narbonne were not immediately evident. The first dedication mentioned is for the leprosarium of the Bourg. On 26 May 1208 Petrus de Fons bequeathed oil to light the lamps in the ‘church of Saint Matthew of the lepers of the Bourg of Narbonne’.6 We have to wait almost sixty years before we have confirmation of the name of the leprosarium of the Cité’s church. The first recorded mention of Saint Laurence was in a land sale between Guillelmus and Sicard Fabri and the administrator of the leprosarium dated 4 September 1266.7 Despite the appearance of these dedications, they are rarely used and remained firmly connected to their physical location.

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Siena’s leper houses do not appear in the documentation until the thirteenth century. This is late compared to Narbonne, or even other leper houses in northern Italy.8 Considering the small number of extant sources for Siena’s leprosaria, it reasons that the houses pre-​date their earliest mention. On 25 August 1229 Guido Terçorini sold a property to the rector of the Ospedale di Santa Maria della Scala, in which he stipulated that a quarter of the land in question was to be given ‘in the name of the lepers of Terzole’.9 The first mention of the leprosarium of Corpo Santo appears in a statute from the 1262 Constituto regulating funds going to religious houses.10 The leprosarium of Corpo Santo does not appear in any documentation outside the Constituto. The dedication of a leprosarium speaks to the local perceptions of lepers. Neither Saint Matthew nor Saint Laurence was a traditional name for leprosaria or their spiritual patrons.11 Nonetheless, the invocation of Saint Matthew fits in with the use of San Lazaro and Corpo Santo in Siena, because all these dedications have connections to the life or body of Christ. Frequently, as was the case at Siena, leprosaria were dedicated to Lazarus, who was described in the Gospel of Luke as ‘a certain beggar, named Lazarus, who lay at his [the rich man’s] gate full of sores’.12 The Gospel of Matthew includes a story where an unnamed leper asks Christ to make him ‘clean’ (mundare), which Christ does.13 The choice to consecrate the church of the leprosarium of the Bourg in Narbonne to Matthew could have been in an effort to link it with Christ’s ability to heal lepers. Perhaps, through the lepers’ devotion, and that of those serving them, they could be healed of their illnesses, both physical and spiritual. Saint Laurence, however, was not associated with lepers, although it is possible to understand why he was chosen. Narbonne had political, linguistic and cultural ties to the Crown of Aragon in this period. Saint Laurence was born in Huesca in the third century. There are several healing miracles ascribed to him, including curing a woman’s headaches and giving a blind man his sight by laying his hands on them both.14 Additionally, while imprisoned in Rome, Laurence met a pagan aristocrat who had wept himself blind, whom he healed and baptised.15 His curative miracles and his compassion for the poor and marginalised make Saint Laurence a suitable, if unusual, patron for the lepers of the Cité of Narbonne.

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As previously mentioned, in Narbonne the leprosaria were not strongly associated with their patron saints; instead they were identified by their geographic location. This gives the impression that the houses were woven into the fabric of the city, whereas the dedications of San Lazaro and Corpo Santo in Siena indicate that the leprosaria were more closely tied to that city’s religious life.

Sources One of the main struggles with comparative studies is finding analogous sources. The kinds of documents relating to leprosy that were issued by the municipal bodies –​the Commune in Siena and the Consuls in Narbonne –​are not the same. The references for the Commune will be taken from the Constituto, which is a compilation of legislation governing the behaviour of the people and institutions of Siena. The Constituto was circulated throughout the city.16 The Consuls of Narbonne, on the other hand, issued specific rulings and acts regarding the leprosaria and their inhabitants, often correcting the conduct of the city’s houses. Sources also include acts and testaments from all strata of society, from weavers to men who served as consuls, making donations to the leprosaria in both the Cité and the Bourg, as well as administrative documents issued by the municipal authorities after 1260. In these documentary sources we see how the leprosarium as an institution played a vital role in shaping how lepers were understood and, by extension, regulated. The documents relating to the leprosaria, namely donations and testaments, reinforce the importance of the collective community and the lepers’ relationship with the healthy and pious people of Narbonne and Siena. The nature of these documents, however, means that the individual leper’s voice is absent. What we do see is that the collective leper, as represented by the institution itself, has a strong presence in the sources. I  will not go into detail about the donations themselves –​they are standard gifts of money and property  –​however, they are all directed at the domus as an institution, not at a specific leper or other person. When new members of the familia were admitted to the leper house, records of which only survive for Narbonne, they promised to serve the house

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as a whole. For example, on 11 August 1311, when Bernardus de Perpignan entered the leprosarium of the Bourg he vowed that he would perform his works of mercy for the house.17 He pledged himself to the institution, as opposed to the individual or collective sick, because the house represented a legitimate, charitable body. By directing their bequests or actions to the domus, donors ensured that the ‘right’ or ‘deserving’ persons would benefit, meaning that, in turn, their own salvation was not put at risk. Unfortunately, there are very few wills and donations mentioning the leprosaria in Siena. In August 1284, Renaldus left ‘to the lepers of San Lazaro at Terzole’ (‘Infectis sancti laçari a terçole’) two pieces of land in a field in the contrada of Caggiolo.18 Ten years later, Ildobrandinus de Mancum stated in his will that every 21 October, in perpetuity, the domus Sancti Lacçarii, as well as the other assistive institutions in Siena, was to receive a part of the revenue that the brothers of San Agostino of Siena gained from the sale of their fruit.19 It is difficult to glean much from these wills; however, considering that the leper house is listed among the other major hospitals, it tells us that San Lazaro was understood to be part of the city’s network of assistance. The lepers within these institutions also gained a legitimate status, which is particularly evident in the instance of Narbonne. Becoming a leper in many ways involved surrendering one’s status as an individual and being considered as part of a community: lepers moved from the singular to the plural.

Lepers within and outside the leprosaria Carole Rawcliffe states that medieval religious and municipal authorities viewed lepers as either ‘wild’ or ‘tame’, which allowed those authorities to entertain the divergent conceptualisations of leprosy.20 Vagrant lepers, who wandered and begged for alms, represented a potential danger to the community, and if left unchecked they would engage in corruptive behaviour. City officials were especially concerned about their contact with sex workers.21 Sex was considered the easiest way to spread disease in a community; therefore, curtailing the free movement of lepers and sex workers was tantamount to a public health initiative. In contrast, the ‘tame’ leper entered the regulated, devout environment of the leprosarium,

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becoming part of a community of lepers. This collective identity followed that of monastic communities, and was encouraged by municipal authorities, particularly from the mid-​thirteenth century onwards. These lepers lived in service of God, and interceded on behalf of the souls of those who supported them through donations and care. Those lepers who shared a collective identity within a leprosarium were considered deserving of compassion and charity in the eyes of the healthy population. While ‘wild’ lepers did wander in groups,22 the collective leper in this context existed within an institutional space and conformed to living a life of service. It was the leprosarium that gave these lepers legitimacy. The leper who pursued an individual, extra-​ institutional existence, in contrast, was considered an unknown entity, one who posed a risk of contamination and corruption to society, and thus needed to be regulated. The status of the leprosi who resided in the leprosaria as worthy recipients of alms was vital to the prosperity and indeed survival of these institutions, since charitable donations made up a large part of their income and enabled them to amass landholdings and other investments.23 Without dipping into the debate over whether or not medieval donors were motivated by compassion,24 there was a prevailing anxiety in the twelfth and thirteenth centuries about whether the individuals or institutions receiving alms, or benefiting from pious bequests, were actually deserving.25 This fear is evident in the consular acts from Narbonne and in the Constituto from Siena. The fear of deception also hints at a larger concern about the proper function and management of the charitable institutions that people were patronising or serving. Understanding these concerns, and the responses to them, both practically and from a normative stance, helps us to contextualise how the leper was defined.

Identifiable leprosi As historians, we usually find reference to the socially sanctioned plural leprosi who chose to live in a leprosarium. We do, however, find instances of individual, named lepers during the period before the Black Death. Later, for example in Rouen, we see an increase in the frequency of named individuals recognised as lepers between

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the fourteenth and sixteenth centuries.26 This is largely due to the presence of formal examination procedures for diagnosing a person with leprosy.27 As we will see, there is a surviving example of a medical examination from Siena in 1250. No such records exist for Narbonne; the lepers and leprosaria disappear from the documentary record in the early fifteenth century.28 In some instances in leprosaria the lepers have cognomens related to their illness, without which it would be difficult to determine, with any certainty, which named members of the house were sick and which were there to serve them. The presence of named lepers is rare in the documentation; however, the collective leper remains a constant. Specifically, we see the use of leprosus in Narbonne and infectus in Siena, both of which are tied to the concept of disease, unlike the other term, misellus, which had a more charitable connotation.29 In Narbonne there are three extant examples of individuals identified as lepers. The first comes from what is probably the foundation of the leprosarium of the Bourg, located outside the city’s walls. On 22 September 1106, Hugo Arnaldi, his wife Bernarda and their children sold a mansus: ‘to you Batalla leprosus, and all the lepers who are or will come to be in your house after your death, thus we grant to you and them your entire manse and garden which you have built’.30 Batalla paid 4 sous for the mansus, which secured the property rights in perpetuity for the lepers. This fee was symbolic, and allows us to characterise Arnaldi’s sale as charitable.31 The document directed the donation to Batalla, which makes him not only the head of the community, but also potentially the founder of the leprosarium.32 It was not uncommon for a group of lepers to evolve into a more formalised leprosarium over time.33 No further citations of Batalla survive among the records. The second example is a land exchange from 20 March 1167, which lists Arnaldus, Geraldus, Petrus and Raimundus as infirm[us] receiving the land on behalf of the leprosarium of the Cité.34 The third regards the transfer of a significant sum of money to the leprosarium of the Bourg. In April 1220, a document was issued stating:  ‘I, Arnaldus de Montseret leprosus, and I, Guillelmus de Quillan leprosus, and I, Martinus de Bage, brother. Together we all acknowledge and in truth recognise you, Guillelmus Arnaldus, merchant have paid us … those 1,000 Melgorian sous.’35 The leper house used the sum to buy land, the rents of which would serve

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to endow the house’s priest.36 These three men are witnessing the transaction, just as Arnaldus, Geraldus, Petrus and Raimundus had fifty-​three years earlier. It should be noted that Arnaud de Montseret  also appeared in a land sale concerning the leprosarium of the Bourg from 22 December 1212. However, here he was not identified as a leprosus; incidentally he had no title at all.37 It is possible, that, in the intervening eight years, he became symptomatic, which resulted in his being identified as leprosus in 1220. As discussed above, Batalla and the lepers mentioned in 1167 and 1220 were receiving these goods on behalf of the leprosarium, thus acting as the administrator. With so few examples, it is difficult to generalise with respect to the agency or authority that individual lepers could possess within the leprosarium community. There are no extant law codes for Narbonne dictating their lives. It is possible they retained some control over their property, or could remain married once they entered the house, like their healthy counterparts.38 It does appear that, at least in the early history of these houses, lepers had some role in the administration of their affairs. After 1220, however, there are no further mentions of individual lepers in the documentation of the leprosaria of Narbonne. Instead, the non-​leprous administrator becomes the point of contact with the outside world and the sick either appear as collective infirmi or remain absent in favour of the members of the healthy familia who lived alongside them. For the majority of their respective histories, the leprosaria in Narbonne and Siena were overseen by a ‘healthy’ administrator rather than by a leper from the house.39 As we have seen in the case of Batalla leprosus, however, there were indeed instances when lepers played a more significant role in the management of their leprosarium. We know very little about what life was like in Siena’s leprosaria of San Lazaro and Corpo Santo; nonetheless, there are a few poignant glimpses into their communities. In 1304, the Consiglio Generale (General Council) ruled that the rector of the domus infectorum sancti laççari, who was named Raynone Infectus, was the rightful administrator of the house, despite his position being contested by a certain Giovanni di Neri. Raynone’s cognomen strongly indicates that he was one of the leprous members of the community. The Consiglio Generale’s ruling reveals that it was

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supportive of an administration of the house by this leprous man. Neri had gone so far as to drive the lepers away from the house and to seize control of their holdings in an effort to secure his claim. The judgement from the Consiglio Generale states that the holdings of the leprosarium were to be placed under the control of the Commune, and ordered the lepers to be allowed to return to their home.40 It is not unsurprising that Neri attempted to install himself as rector, because that office would have given him power over the property and goods of the house. Control over the patrimony of a leprosarium was the cornerstone of an administrator’s authority. It is possible that Raynone’s infirmity made his authority vulnerable, and that this situation was exploited by Giovanni di Neri. Raynone’s inability to protect San Lazaro’s lands from forced seizure would explain why the Commune chose to place the holdings under its own care, therefore reinforcing the city’s commitment to protecting the integrity of the leprosaria. There is another, well-​known instance of a named leper in Siena; here, the leprous man appears in the documentation at the moment at which he was declared a leper. Unlike the aforementioned individuals, he was not yet a member of a leprosarium community; no sources shed light on his fate after his diagnosis. This instance has been discussed by Luke Demaitre and others because it is one of the earliest accounts of diagnostic examination of a person suspected of having leprosy.41 In April 1250 Pierzivallus was told to live ‘with those of San Lazaro’.42 Four physicians, on the command of the podestà and the Consiglio Generale, had ‘seen and pronounced whether Pierzivallus was infected; judged and sentenced him as a leper’.43 Specifically, the document uses the word infectus to describe Pierzivallus’s new state. He was given 10 libri as part of his ‘entry fee’ for San Lazaro.44 We know from the 1262 Constituto that entry into San Lazaro, which may have also applied to Corpo Santo, was predicated on proof that the individual was a leper.45 Additionally, when a leper chose to enter the leprosarium they were to bring a quarter of their property with them, which was used to support them.46 The physicians petitioned the Commune to be paid for services rendered, which is how we know about Pierzivallus’s case. Physicians in Siena were not permitted to be part of the Nine (the civic government) and were largely absent even from lower offices,47 which can be interpreted as indicating that they were

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independent consultants. Considering that the Constituto demands proof of illness, it stands to reason that the Commune required physicians to examine possible cases of leprosy. What unites the examples from Narbonne with this one from Siena is the sense that when a person contracted leprosy the disease became a piece of his or her identity, to the point that a label denoting leprosy became part of his or her name. These cognomens also associate the person with their institution. Here the word ‘leper’, or leprosus/​infectus, was a mark of change, from healthy to sick, from the world inside the city walls to living outside the city, within the leprosarium. It is possible that only those individuals who joined leper houses received the cognomen leprosus or infectus, and that those who did not conform to this requirement did not. However, with so few examples it is impossible to say with any certainty. The named lepers, such as Batalla or Raynone, occasionally served as representatives of the collective leper, and helped to legitimise the house as a proper community in the eyes of the wider population.

Regulating leprosy and leprosaria The notion that lepers needed to conform to the expectation of membership of a devout community of fellow leprosi played an important role in shaping how the ‘leper’ was defined by the municipal authorities in Narbonne and Siena. For Siena, significant information survives regarding the regulation of lepers by the municipality. The leprosaria may not have emerged in the extant documentation until the early thirteenth century, but by the second half of that century the Commune already had a strong track record of regulating the presence of lepers in Siena. Beginning in 1246, there are several references to individuals being rewarded for expelling lepers, called malagdi, from the city.48 The earliest extant statute regulating their removal appears in 1262, which will be discussed below, although no explicit reasoning is presented in the text. These men were hired to enforce a statute that may have been motivated either by concerns regarding hygiene or as a means of regulating and differentiating between local and foreign lepers –​ the Commune only permitted foreign lepers inside the city during Easter.49 No such statute exists for Narbonne. Considering that the

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city’s payment of these individuals was recorded in the Biccherna, the records from the central finance office, it is reasonable to assume that there was a civic ordinance instructing this behaviour towards lepers. The first, and only extant, statute expelling the lepers from Siena comes from the fifth distinctio of the 1262 Constituto, which is primarily concerned with the criminal code and policing the city.50 The two statutes dealing with lepers in this section can be seen as working in tandem. The first, Statute 121, orders that beginning in January, property owners found to be housing lepers within 2 km of the city will be fined 100 solidi di denari for each infraction. Naturally, the two leprosaria were not subject to this rule. The next regulation, Statute 122, takes this one step further. It states that in the same month, the Commune would choose three men from each administrative district (terzo) to find and remove the leprosi from within the walls of Siena.51 It goes on to say that the lepers would be permitted to return and stay in the city during Holy Week, a period that played an important role in the civic religion of Siena. The statute does not provide any specific guidelines about which days the lepers would enter the city or where specifically they were allowed to go once there.52 While this provision was not rare, it was not all that common either. We see evidence of similar provisions from a will in Rouen from 1304 and from Nuremberg in the fifteenth century. In both cities lepers were permitted entrance for the week preceding Easter.53 It is possible that the lepers were there to be a visible reminder of the deserving poor. The Sienese statutes permitted those lepers who were living in San Lazaro to go through the city with bells.54 For reasons unknown, the same provision was not extended to Corpo Santo. Ringing a bell or sounding a clapper was intended to draw a healthy person’s attention to the presence of the leper.55 Fundamentally, bells were markers of sanctioned begging. Lepers were ideal participants in celebrations such as Holy Week, as their worthiness was displayed for all to see and hear. The leper in this context was someone who needed to be identified and moved to a leprosarium. The fine against the property holder was a means of discouraging family members from caring for, and concealing, afflicted kin. Additionally, the same document orders that the Commune must send any Sienese citizen who became a leper to San Lazaro, which was obliged to receive them.56 San

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Lazaro was the most heavily regulated of the two houses, which could indicate that it occupied a more prominent place in the urban landscape than Corpo Santo. That being said, there is no indication that the Commune directly managed San Lazaro beyond offering its protection. The legislation is concerned with the individual or hidden leper who was unaccounted for. The leprosi, or the plural leper, gained a new identity as a member of the leprosarium community, and was no longer subject to such scrutiny. Governing the leper was a three-​ tiered effort. Ecclesiastical bodies, particularly the Third Lateran Council in 1179, sought to provide religious structure for leprosaria. Unfortunately, there is no extant ecclesiastical legislation for either city that governs lepers. Lay authorities regulated the behaviour of leprosy sufferers through laws and ordinances. Some leprosaria were regulated by sets of statutes that could be supplied by the local episcopal authority.57 The most significant set of ecclesiastical instructions regarding leprosy were set out in Canon 23 of the aforementioned Council. This oft-​cited canon was the basis for supporting lepers’ access to religious services. It criticised priests and ecclesiastics who barred lepers from having their own churches and ministers.58 More importantly, it instructed the lepers to be ‘gathered together under a common way of life’, thereby establishing a loose religious community that housed and gave purpose to the afflicted.59 People who subscribed to this life were permitted access to various services and exemptions, which, though not expressly outlined in the canon, included long-​term care through membership of a religious community. The 1262 Constituto is superficially at odds with Third Lateran; however, as discussed in the case of Pierzivallus, those individuals proven to be lepers were offered admission to a leprosarium supported by the Commune. The Constituto focused on restrictive measures towards unaffiliated lepers; however, the Commune did also provide incentives for those who joined the communities of the leprosaria. Here lepers are being separated for the sake of public health, not for malicious reasons. Like other charitable institutions of the city, San Lazaro was granted the Commune’s protection, meaning that the lepers themselves came under the jurisdiction of the Commune. This protection extended to the wider community of the leprosarium, since it encompassed the people who worked on

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its lands.60 In the 1309 Constituto the city instructed that its coat of arms should be installed on the main doors of San Lazaro and two hospitals: Casa della Misericordia and the Ospedale di Santa Maria della Scala.61 The coat of arms was an emblem of the Commune’s protection. Additionally, the same document donated 30 libre di denari to the rector of San Lazaro for the purpose of alleviating the suffering and poverty of the maladdi. It is striking that, while the lepers were the collective beneficiaries of the Commune’s funds, we see again that they had no voice of their own beyond the use of bells, and their representative was the leprosarium’s non-​leprous administrator.62 The true reward of the ‘tame’ or collective leper in Siena, a status that was obviously only extended to those living in either one of the leprosaria, was permission to ring a bell within the city walls.63 This version of the leper in many ways embodies the ideal. It signified not only that this individual lived with a community of their peers, but also that such communities were sanctioned by the city as deserving. If lepers did not conform, then they were unable to access a wide array of services and benefits, including religious benefits, and consequently, were seen as a potential risk that needed to be removed from society. In Narbonne, the municipal authorities also became involved in regulating matters relating to leprosy and leprosaria. The Consuls of the Cité and the Bourg, respectively, had a different approach to protecting and regulating lepers in their city from that of the Commune of Siena, and took a more active role in the management of their leper houses. In the late thirteenth century, the Consuls of both the Cité and the Bourg extended their protection over the leprosaria by swearing an oath in which they stated that they had the authority to appoint and dismiss any administrator, brother or sister of the leprosaria whom they judged to be contravening the duties of their position, as well as annually to review the houses’ accounts. These measures were all designed to prevent corruption or wrongdoing within the leprosaria, because the wellbeing of the lepers themselves, and the integrity of the charity offered to them, were supposed to be protected. On 5 August 1308, the royal bailiff of Narbonne, under the instructions of the Seneschal of Carcassonne, issued a mandate to the Consuls of the Bourg, granting them ‘control and management

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and correction of the hospital of the poor and the lepers and of the communal charity of the said Bourg and their possessions’.64 On one hand, this was a formality, as the Consuls had already made it clear that they had this level of authority over the leprosarium. However, by the early fourteenth century Narbonne found itself becoming more and more integrated into France, which accounts for the appearance of agents of the Crown in local politics.65 For the Consuls, having their authority over the leprosarium and the hospital confirmed by the royal bailiff not only reinforced, but also fully secured, their role in the management of assistive institutions in the Bourg. It is possible that a similar provision was extended to the Consuls of the Cité, although no such document survives. Corruption was indeed an issue during this period. As we saw earlier, on 11 August 1311 Bernardus de Perpignan, a weaver, was received into the leprosarium of the Bourg as administrator to replace his predecessor, Brother Bernardus Hospitalis, who had been dismissed because he had wrought devastation on the house.66 Hospitalis, however, was not removed from the house. He was to stay on at the leprosarium, probably because of prolonged exposure to the illness, and was to receive a punitive diet of bread and water.67 Evidently his poor management had put the house at risk, making his dismissal necessary. Hospitalis’s removal from office was a means of insulating the lepers and the wider familia of the leprosarium from his corruption. If the institution became disreputable, the lepers there would no longer be considered deserving, discouraging donations to, and pious support for, the community. If the corruption within the house could be contained to one person, then the lepers within retained their positive, collective connotation.

Conclusion In medieval Narbonne and Siena, ‘leper’ was a complex word that held different connotations for different groups. In terms of my case studies, there is no evidence that can shed light on how lepers viewed and defined themselves. From the perspective of the extant documentation there were two kinds of lepers. The Constituto of Siena illustrates the importance placed on conformity, an idea that

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is also expressed in the language used in the donations and bequests in both cities. Expelling lepers and limiting their movements meant that the Sienese Commune could separate lepers from their healthy fellow citizens, while also providing them with institutional care under the protection of the city. In Narbonne, the leper lived a comparatively quiet life where he or she benefited from the pious inclinations of the city’s population. That being said, both cities were preoccupied with protecting their leprosaria from corruption, both internal and external. The collective leper who lived in the leprosarium was not only the deserving leper, but also one who posed no risk to the healthy population. In certain sources, such as council rulings from Siena and donations from Narbonne, we have individually named lepers who served as proxies for their house, casting them as representatives of the plural leper. This deserving leper was juxtaposed against the ‘wild’ leper who, on account of being unattached to a leprosarium, could not enjoy the benefits of community life such as access to religious facilities and care. Ultimately, the positive connotation of ‘leper,’ in both Narbonne and Siena, was an individual who joined a community of fellow sufferers, and fulfilled his or her duty as an intercessor for the pious of the city. These lepers’ intercessory acts marked them as individuals worthy of receiving care and financial assistance.

Notes 1 I am grateful to Dr Elma Brenner for the opportunity to contribute to this volume, as well as her guidance and feedback. I would also like to thank Dr Fernando Arias Guillén, Dr Andrew Dunning and Courtney A. Krolikoski for their support. All translations are my own unless otherwise indicated. 1 I have elected to use the word ‘leper’ in order to be faithful to the original language. I use the term knowing that today it has a complex and often derogatory meaning; however, in the cases presented here, we will see that the modern meaning has no bearing on the medieval context. 2 C. Devic and J. Vaissete (eds), Histoire générale de Languedoc, 10 vols (Toulouse: J.-​B. Paya, 1840–​46), Vol. VIII, pp. 1410–​11, Vol. VI, pp. 858–​62; W. C. Jordan, Louis IX and the Challenge of the Crusade: A Study in Rulership (Princeton: Princeton University Press, 1979), pp. 199–​200; J. Given, State and Society in Medieval Europe: Gwynedd

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and Languedoc under Outside Rule (Ithaca, NY:  Cornell University Press, 1992), pp. 192–​3; J. Firnhaber-​Baker, Violence and the State in Languedoc, 1250–​1400 (Cambridge:  Cambridge University Press, 2014), pp. 37–​8. 3 J. Caille, ‘Historical overview: Narbonne from Roman foundations to the fifteenth century’, in K. L. Reyerson (ed.), Medieval Narbonne: A City at the Heart of the Troubadour World (Aldershot: Ashgate, 2005), pp. 1–​56 (pp. 11–​12). 4 W. Bowsky, A Medieval Italian Commune: Siena under the Nine, 1287–​ 1355 (Berkeley:  University of California Press, 1981), pp.  23–​4; O. Redon, ‘Qualche considerazione sulle magistrature forestiere a Siena nel duecento e nella prima metà del trecento’, in J.-​C. Maire Vigueur (ed.), I podestà dell’Italia Comunale:  Reclutamento e circolazione degli ufficiali forestieri (fine XII sec.–​metà XIV sec.) (Rome: Instituto Storico Italiano, 2000), pp.  659–​ 74 (pp. 659–​ 62); J.-​ C. Marie Vigueur, Cavaliers et citoyens: Guerre, conflits et société dans l’Italie communale, XIIe–​XIIIe siècles (Paris:  Editions de l’Ecole des hautes études en sciences sociales, 2003), pp. 337–​62. 5 D. Waley, Siena and the Sienese in the Thirteenth Century (Cambridge: Cambridge University Press, 1991), pp. 46–​7. 6 ‘[E]‌cclesie Sancti Mathei missellorum burgi Narbone’, Paris, Archives nationales (AN), S 4858 B, no. 74. 7 J. Caille, Les hôpitaux et charité publique à Narbonne au Moyen Age de la fin du XIe à la fin du XVe siècle (Toulouse: Privat, 1978), p. 33; M. G. Mouynès, Inventaire des archives communales antérieures à 1790, Sèries AA (Narbonne: E. Caillard, 1877), p. 91, regarding Narbonne, Archives municipales (AMN), AA 104, fos. 183v–​184v. 8 For Italy, see Piacenza, 1088 (E. N. Rocca, ‘L’Ospedale di S. Lazzaro di Piacenza’, Archivio Storico per le Province Parmensi, 35 (1935), 143–​85 (p. 144)); Pavia, 1157 (F.-​O. Touati, ‘San Lazzaro di Pavia:  Genèse d’une léproserie lombarde au Moyen Age’, in D. Barthélemy and J. M. Martin (eds), Liber largitorius: Etudes d’histoire médiévale offertes à Pierre Toubert par ses élèves, Ecole Pratique des Hautes Etudes, Sciences Historiques et Philologiques, 5(84) (Geneva: Droz, 2003), pp. 277–​302 (p. 285)); Verona, 1225 (G. de Sandre Gasparini and M. C. Rossi (eds), Malsani: Lebbra e lebbrosi nel medioevo (Verona: Editrice Antenore, 2012), p. xxxiii). 9 ‘[N]‌omine Malesanorum de terçole’, Siena, Archivio di Stato (ASS), Diplomatico Ospedale Santa Maria della Scala (DOSMS), 25 August 1229, carta 48. 10 ‘About the judge to be appointed to supervise that which is to be recognised as having been given legacies to the Opera Santa Maria

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and Fratribus predicatoribus and the Friars Minor and to other religious locations’ (‘De iudice dando super agnoscendis legatis factis opere Sancti Marie et Fratribus Predicatoribus et Minoribus et  aliis locis religiosis’): L. Zdekauer (ed.), Il constituto del comune di Siena dell’anno 1262 (Bologna: A. Forni, 1983) (COST 1262), p. 30. 11 Caille, Hôpitaux, p. 139. 12 Luke 16:20–​ 1. On Saint Lazarus and his significance for leprosy sufferers and leprosaria, see R. Hyacinthe, Chapter 10 in this volume (pp. 294–​322). 13 Matthew  8:2–​4. 14 D. Farmer, The Oxford Dictionary of Saints (Oxford: Oxford University Press, 2004), pp. 311–​12; J. de Voragine, The Golden Legend: Readings on the Saints, trans. W. G. Ryan, Vol. II (Princeton: Princeton University Press, 1995), pp. 63–​5. 15 J. Wogan-​Browne and G. S. Burgess (trans. and eds.), Virgin Lives and Holy Deaths: Two Exemplary Biographies for Anglo-​Norman Women (London: Dent, 1996), p. 49. 16 Bowsky, Medieval Italian Commune, p. 95. 17 ‘I, Bernardus de Perpignan, a weaver from the Bourg of Narbonne, agreeing and considering works of compassion and mercy that happen daily in the leprosarium of the Bourg, desiring to end my days in the same place, serving the Lord and tending to its poor’ (‘Ego B. Perpenani textor de burgo narbonem accordens et considerans opera pietatis et misericordie quae fiunt cotidie in domo leprosorum burgi cupiens ibidem dies meos finire domino famulando et pauperibus serviendo eiusdem ibidem’). Paris, BnF, Doat 51, fos 364–​364v/​AN, S 4858 B, no. 47. 18 ASS, DOSMS, 16 August 1284, carta 276. 19 Ibid., 21 October 1294, carta 356. 20 Rawcliffe, Leprosy, p. 284. 21 Ibid., pp. 284–​5; J. Avril, ‘Le IIIe Concile du Latran et les communautés de lépreux’, Revue Mabillon, 60 (1981), 21–​76 (p. 70). 22 See L. Barnhouse, Chapter 7 in this volume (pp. 183–​207). 23 E. Brenner, Leprosy and Charity in Medieval Rouen (Woodbridge: Boydell Press, 2015), pp. 19–​57. 24 For a discussion of compassion and charity, see A. Davis, ‘Hospitals, charity, and the culture of compassion in the twelfth and thirteenth centuries’, in S. Farmer (ed.), Approaches to Poverty in Medieval Europe: Complexities, Contradictions, Transformations, c. 1100–​1500 (Turnhout: Brepols, 2016), pp. 23–​45. 25 N. Bériou, ‘Les lépreux sous le regard des prédicateurs d’après les collections de sermons ad status du XIIIe siècle’, in N. Bériou and

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F.-​O. Touati (eds), Voluntate Dei leprosus: Les lépreux entre conversion et exclusion aux XIIème et XIIIème siècles, Testi, Studi, Strumenti, 4 (Spoleto: Centro italiano di studi sull’Alto medioevo, 1991), pp. 33–​80 (pp. 48–​52); J. Bird, ‘Medicine for body and soul: Jacques de Vitry’s sermons to hospitallers and their charges’, in P. Biller and J. Ziegler (eds), Religion and Medicine in the Middle Ages (Woodbridge: York Medieval Press, 2001), pp. 96–​108; A. Davis, ‘Preaching in thirteenth-​ century hospitals’, Journal of Medieval History, 36(1) (2010), 83–​6. 26 Brenner, Leprosy and Charity, pp. 55, 106–​7. 27 Demaitre, Leprosy, pp.  37–​ 74. On leprosy examinations also see Barnhouse, Chapter 7 in this volume. 28 Bibliothèque Municipale de Narbonne, MS 314, Vol. IV, fos 399–​400; Caille, Hôpitaux, pp. 44–​5. 29 For more on this see L. Demaitre, Chapter 8 in this volume (p. 208); A.  Peterson, ‘A comparative study of the hospitals and leprosaria in Narbonne, France and Siena, Italy (1080–​1348)’, Ph.D.  dissertation (University of St Andrews, 2017), pp. 48–​67. 30 ‘[T]‌ibi Batalla leproso et omnes leprosos quos [qui] tecum sunt vel venturi erunt in tuam domum post mortem tuam sic donamus tibi et illos [illis] totum tuum mansum et ortum quod habes hedificatum’; AN S 4858 B, nos. 15/​76. Batalla was male, considering the use of ‘leproso’ instead of ‘leprosa’. It should be noted that Batalla was a cognomen adopted by a group of five men from the town of Mirepoix who swore fealty to Ermengard Trencavel in 1070, and the name appears in the documentation for that area until at least 1223:  Devic and Vaissete, Histoire générale de Languedoc, Vol. V, pp.  616–​17; F. L. Cheyette, Ermengard of Narbonne and the World of the Troubadours (Ithaca, NY: Cornell University Press, 2001), p. 194. 31 AN, S 4858 B, nos. 15/​76. 32 Caille, Hôpitaux, p. 57. 33 Touati, Maladie, p. 126; J. Stemmle, ‘From cure to care: Indignation, assistance and leprosy in the high Middle Ages’, in A. M. Scott (ed.), Experiences of Charity, 1250–​ 1650 (London:  Routledge, 2015), pp. 43–​62 (p. 45). 34 AMN, 104, fo. 182v/​GG 2345. 35 ‘Ego Arnaldus de monte sereno leprosus et Ego Guillelmus de quilano leprosus et Ego Martinus de bagis frater. nos omnes pariter profitemur et in veritate recognoscimus tibi Guillelmo arnaldo mercatori quod tu de mandato … ipsius persolvisti nobis illos. m. solidi melgorien’; AN S 4858 B, no. 23. Caille, Hôpitaux, pp. 97, 158. 36 ‘… which Petrus Raimundus Amatus has entrusted to our house in his final will for one priest in our house, to be held in perpetuity’ (‘… quos

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petrus raimundi amatus dimisit domui nostre in sua ultima voluntate pro uno sacerdote in domo nostra in perpetuum tenendo’); AN, S 4858 B, no. 23. 37 Ibid., no. 28; Caille, Hôpitaux, p. 158. 38 Caille, Hôpitaux, pp. 93, 95; C. de Miramon, Les ‘donnés’ au Moyen Age: Une forme de vie religieuse laïque v. 1180–​v. 1500 (Paris: Cerf, 1999), pp. 340–​4. 39 For examples elsewhere, the Order of Saint Lazarus was headed by lepers until 1253, when its members petitioned Pope Innocent IV to allow them to elect a non-​leprous leader:  M. Barber, ‘The Order of St Lazarus and the Crusades’, Catholic Historical Review, 80 (1994), 439–​56 (p. 445); also see R.  Hyacinthe, Chapter  10 in this volume (pp.  294–322). In thirteenth-​ century Toulouse a leprosarium was governed by its lepers:  J. H. Mundy, ‘Hospitals and leprosaries in twelfth-​and early thirteenth-​century Toulouse’, in J. H. Mundy, R. W. Emery and B. N. Nelson (eds), Essays in Medieval Thought: Presented in Honor of Austin Patterson Evans (New  York:  Biblo and Tannen, 1965), pp. 181–​205 (p. 196). 40 ASS, Consiglio Generale 65, fo. 49v; Bowsky, Medieval Italian Commune, p. 274. 41 Archivio di Stato di Siena (ed.), Libri dell’entrata e dell’uscita della Repubblica di Siena detti del Camarlingo e dei quattro provveditori della Biccherna, Libro Settimo a.  1246–​47 (Siena:  Tipografia Cooperativa Ex Combattenti, 1931), p. 71; C. Mazzi, ‘Elenco dei documenti storici spettanti alla medicina, chirurgia e farmacia in Siena’, Archivio Storico Italiano, 9 (1892), 142–​9 (pp. 145–​6); K. Sudhoff, ‘Lepraschaubriefe aus Italien’, Archiv für Geschichte der Medizin, 5 (1912), 434–​ 5 (p. 435); Demaitre, Leprosy, pp. 37, 65, 140–​1. 42 ‘[A]‌ d habitandum cum illis de sancto Lazaro’; Sudhoff, ‘Lepraschaubriefe’, p. 435. 43 ‘[Q]‌ uod viderunt et cognoverunt Pierzivallum si esset infectus iudicaverunt et sententiaverunt eum pro infecto’; ibid. 44 Demaitre, Leprosy, pp. 140–​1. 45 COST 1262, pp.  51–​2; ASS, Statuti 5, fo. 16, Statuti 16, fo. 12v; M.  S. Elsheikh (ed.), Il costituto del Comune di Siena, volgarizzato nel MCCCIX–​MCCCX, Vol. I (Siena: Fondazione Monte dei Paschi di Siena, 2002) (COST 1309), p. 44. 46 COST 1262, p. 51. 47 Bowsky, Medieval Italian Commune, pp. 70–​1. 48 Peterson, ‘A comparative study’, pp. 63–​7, 196–​7. 49 COST 1262, p.  51; ASS, Statuti 5, fo. 16, Statuti 16, fo. 13; COST 1309, pp. 44–​5.

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50 COST 1262, p.  132. COST 1309 has two additional distinctiones. The sixth governs the Nine while the seventh, entitled Sindacamento, outlines the procedure for examining public officials: COST 1309, Vol. II, pp. 529, 591. 51 L. Zdekauer (ed.), ‘Il frammento degli ultimi due libri del più antico constituto senese, 1262–​1270’, Bullettino Senese di Storia Patria, 1 (1894), 137–​44, 315–​22 (pp. 137–​8). 52 COST 1262, p.  51; ASS, Statuti 5, fo. 16, Statuti 16, fo. 13; COST 1309, pp. 44–​5. 53 E. Brenner, ‘Outside the city walls:  Leprosy, exclusion, and social identity in twelfth-​and thirteenth-​ century Rouen’, in M. Cohen and J.  Firnhaber-​Baker (eds), Difference and Identity in Francia and 55 (p. 150); Medieval France (Farnham:  Ashgate, 2010), pp.  139–​ Demaitre, Leprosy, p. 46. 54 COST 1262, p. 51; ASS, Statuti 3, fo. 7. 55 Rawcliffe, Leprosy, pp.  14, 199; F.-​ O. Touati, ‘Contagion and leprosy: Myth, ideas and evolution in medieval minds and societies’, in L. I. Conrad and D. Wujastyk (eds), Contagion: Perspectives from Pre-​Modern Societies (Ashgate:  Aldershot, 2000), pp.  179–​ 202 (pp.  184–​5). Demaitre notes in Chapter  8 of this volume that bells are largely found in the iconography of medieval England, whereas clappers are seen in artwork from the Continent (p.  223). To my knowledge, there is no artwork from this period in Siena depicting lepers with either bells or clappers. 56 COST 1262, pp. 51–​2. 57 See L. Le Grand (ed.), Statuts d’Hôtels-​Dieu et de léproseries: Recueil de textes du XIIe au XIVe siècle (Paris: Picard, 1901). 58 N. P. Tanner (ed. and trans.), Decrees of the Ecumenical Councils, Vol. I (London: Sheed and Ward, 1990), p. 222. 59 ‘[S]‌ub communi vita fuerint congregati’. Ibid. Avril, ‘Le IIIe Concile’, pp. 22–​3. 60 COST 1309, p. 45. 61 Ibid., p. 34; Bowsky, Medieval Italian Commune, pp. 110–​11. 62 COST 1309, p. 64. 63 COST 1262, p. 51; ASS, Statuti 3, fo. 7. 64 ‘[R]‌egimen et gubernationem et correctionem hospitalis pauperum et leprosorum et communis caritatis dicti burgi et bonorum eorumdem’. AN, S 4858 B, no. 49. 65 R. W. Emery, Heresy and Inquisition in Narbonne (New  York: Columbia University Press, 1941), pp. 28–​9, 33–​7; J. Caille, ‘Seigneurs et “peuple” de Narbonne (XIe–​ XVe siècles)’, in J. Michaud and

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A. Cabanis (eds), Histoire de Narbonne (Toulouse:  Privat, 1988), pp. 119–​40 (pp. 129–​31). 66 Paris, BnF, Doat 51, fos 364–​364v/​AN, S 4858 B, no. 47; S 4858 B, no. 48. 67 AN, S 4858 B, no.  11; AMN, AA 107, fo. 11. For more on dietary restrictions as a form of punishment in leprosaria, see E.  Brenner, Chapter 6 in this volume (pp. 171–​2).

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Part V

Post-​medieval perspectives

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12 ‘Our loathsome ancestors’: reinventing medieval leprosy for the modern world, 1850–​1950 Kathleen Vongsathorn and Magnus Vollset Until fairly recently, historians and the public alike believed that leprosy-​affected people in medieval Europe were uniformly excluded and stigmatised.1 This chapter explains how these notions of medieval leprosy were invented for the modern world, and why leprosy’s medieval past became a matter of interest and relevance for nineteenth-​century Europeans. While scholarship on leprosy in the nineteenth and twentieth centuries has flourished, scant attention has been paid to connections between medieval and modern leprosy, or to the early histories of medieval leprosy that have so influenced popular and historical understandings of stigmatising societal responses to leprosy in medieval Europe.2 Yet in the nineteenth and early twentieth century, leprosy’s medieval past was a source of inspiration for, and a counterpoint to, contemporary approaches to leprosy and its management. This chapter investigates the exploration and relevance of leprosy’s medieval European past through three avenues: medicine, empire and philanthropy. To medical professionals in the early 1850s, medieval medical writers were considered colleagues who had experience in dealing with the same disease. Medieval leprosy in Europe then became an object of interest in and of itself, with nineteenth-​ century medical practitioners mapping the rise and fall of the disease in the Middle Ages, as well as gathering facts about responses from medieval society, and practices of care and regulation within individual medieval European leprosaria. Since the disease had apparently disappeared from medieval Europe,3 finding the reasons why was seen as key to figuring out how to act in the present global situation. Some nineteenth-​century practitioners

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connected the disease with backwardness. They argued that leprosy ultimately disappeared from medieval Europe because of increased civilisation, and used this case to justify colonisation in their present time. Others pointed to medieval segregation of people with leprosy, and argued that similar measures must be reiterated in the modern world. By the 1890s, however, the relevance of medieval leprosy had come under attack. The medieval sources could be interpreted to support a wide range of disease models, and increasingly physicians started to question the accuracy of medieval diagnosis and whether claims about the number of leprosy sufferers at this time were inflated. The advent of bacteriology spread further doubts about the actual incidence, and relevance, of medieval leprosy. The medieval physicians had not had access to microscopes or other modern equipment for diagnosis. As the use of bacteriological tests as the ultimate standard for making a diagnosis increased from the turn of the twentieth century, this argument only strengthened. With medieval records increasingly surrounded by doubts, new, current evidence about leprosy was deemed more accurate, in particular national patient records and what these revealed about how the numbers of people with leprosy changed over time. As medical interest in medieval leprosy declined, popular interest in leprosy rose with the ‘leper scare’ of 1889, occasioned by the death of a Belgian missionary afflicted with leprosy in Hawaii: Father Damien. Re-​encounters with leprosy in the tropical empire, and the death of a famous European with leprosy, led to fears of leprosy’s return to European soil. These anxieties, as well as a desire to distance ‘civilised’ Europe from its ‘backward’ colonies, and therefore also from Europe’s medieval, diseased past, led to the denigration of medieval Europeans, whose backwardness was deemed responsible for leprosy, and whose gradual civilisation was believed to have led to its decline. This supposed trajectory, from ‘primitive’ to ‘civilised’, provided an ideal justification for segregating leprosy patients in in-​ patient settlements, in order to guide them through a similar ‘civilising’ process. Though impractical, leprosy settlements were the standard European policy for managing leprosy in the colonial world until the 1950s. Yet leprosy’s perceived medieval past was not only a source of fear, alienation and a desire to control: it also served as inspiration

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for philanthropy towards those supposedly suffering from leprosy. Philanthropists consciously drew on biblical and medieval stories of love and charity towards people affected by the illness to guide their own actions. Drawing on journals, newspapers, medical texts, popular texts and mission archives from across Europe, with a particular emphasis on British sources, this chapter argues that nineteenth-​and twentieth-​century Europeans both looked towards and reinvented their medieval past to understand how leprosy was spread and controlled, to justify medical policies, to support their identity as ‘civilised’ European colonisers and to serve as inspiration for charity towards leprosy-​affected people.

Medical perspectives on medieval leprosy The first nineteenth-​century medical monograph that saw medieval leprosy as directly relevant to contemporary encounters with the disease was Om spedalskhed (On Leprosy) from 1847, written by the Norwegian physicians Daniel Danielssen and Carl Wilhelm Boeck.4 In 1855, the work won the Prix Monthyen from the Academy of Sciences in Paris for clearly separating leprosy from other afflictions of the skin, and according to the famous German pathologist Rudolf Virchow, the monograph ‘laid the foundation for modern leprology’.5 The accompanying coloured atlas by artist Johan Ludvig Losting ensured that the work remained a reference for clinical diagnosis for half a century.6 The first part, written by Boeck, opened with a chronological list of literature on leprosy, starting with the Bible and Hippocrates, followed by almost forty references to medical texts written in the medieval period. At first glance, the goal was simply to be comprehensive and authoritative, through listing references to as many known works on leprosy as possible. A closer reading suggests that the references to medieval leprosy served at least three further functions. First, they showed that the disease, which at the time affected some 2,800 individuals in Norway, had a long and continuous presence in human history. In Norway, the Viking laws that pre-​dated Christianity exempted likthraa-​Mænd (leprosy sufferers) from military service.7 Second, medieval scholars were treated as former colleagues with relevant expertise, particularly when it came to remedies and treatments.

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In other words, there was knowledge to build on in the search for a cure. Third, the medieval works on leprosy showed the hopes and pitfalls in how past societies had dealt with those affected by the disease:  leprosy had been widespread in medieval Europe, most experts had believed it was contagious, and segregation in specialised institutions known as leprosaria had been the norm. This latter point held an important lesson for the present:  the example of medieval leprosy showed that through active measures the disease had disappeared previously from much of Europe and, therefore, that it could be eliminated again. Indeed, Boeck wrote: ‘Most of Europe has in an earlier period been terribly affected by the disease, but managed through severe precautions to rid itself of it. Now we are faced with the same disease as other countries in medieval times, and need to choose a similar path if we want to avoid the populations in certain areas perishing from the disease.’8 However, the message did not come without a warning: the cost to those affected had been vast and unnecessary. According to Boeck’s presentation of medieval leprosy, ‘lepers’ had been forced to live outside the city gates and could only enter town on special days; they had to wear distinctive clothing and shake a ‘leper clapper’ to warn others of their presence; they were excluded from church services, considered ‘dead among the living’ and lost their legal status; and some were even burned, or buried alive.9 The ‘cruel and inhumane’ policies in medieval Europe all boiled down to a mistaken belief that leprosy was contagious. To Danielssen and Boeck, leprosy was a ‘family disease’ (of 213 cases they had examined in Norway, 189 were considered due to heredity, while only 24 had appeared spontaneously),10 and the disappearance of the disease had merely been a side effect of discouraging those affected from spreading it through having offspring. Probably, Boeck’s selective reading of medieval texts, highlighting the cruelty of how people with the disease were treated by medieval society, was aimed at ensuring that the message struck home: society should react, but treating people affected by leprosy as contagious inadvertently led to inhumane and cruel treatment. The index even had its own entry on ‘The cruel persecution that they [leprosy sufferers] were exposed to’.11 The book also discussed the specialised houses that had been erected for those suffering from the disease: ‘Misellaria, Mezelleries,

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Ladreries, Maladreries, Lazaretti, Aussatshäuser, Malanterie, Leper-​Hospitals, leprosarier’.12 In the centuries following the establishment of a leprosarium in Charolais, France, in 571 CE, the number of such institutions in Europe grew rapidly. Around 1250, Matthew Paris estimated that there were 19,000 leprosaria in the Christian world, 2,000 of them in France.13 Stressing that the numbers should be taken with a big grain of salt, Boeck nonetheless argued that leprosy had been relatively widespread. Danielssen and Boeck’s publication, with its references to medieval leprosy, had direct political implications. In Norway, which was highlighted at the First International Leprosy Conference in Berlin in 1897 as the only country that had succeeded in getting a modern leprosy epidemic under control,14 the State built a research hospital for Danielssen in Bergen, charged with finding a cure (Lungegaardshospitalet). In 1850, based on the premise that the disease was hereditary, it was suggested that leprosy sufferers and their families should be denied the right to get married, but this failed after protests from the Church. In 1856, Norway instead established a national patient registry and three institutions to provide ‘good homes’ for those affected by the disease.15 The rationale was partly to alleviate the expenses for municipalities with high prevalence, and partly to ensure that those affected did not need to depend upon having children to take care of them when they were old, thereby breaking the hereditary taint. Elsewhere, the reception of Danielssen and Boeck was radically different. In Iceland, where leprosy was also prevalent in the nineteenth century, all four leprosaria were abolished in 1848, with reference to new science that now showed the disease not to be contagious.16 In the British Empire, after reports that leprosy had been encountered in the colonies and amid worries that it might be contagious, the Colonial Office issued a Report on Leprosy (1867), which concluded that leprosy was ‘essentially a constitutional disorder’, best tackled by improving the health, diet and living conditions of indigenous populations. The disease posed no risk to European colonialism and, referring to Danielssen and Boeck, the report concluded that ‘any laws affecting the personal liberty of lepers ought to be repealed, [and] any action of the Executive Authority not enjoined by the law, ought to cease’.17

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Rudolf Virchow visited Danielssen in 1859, after being invited to evaluate the Norwegian leprosy campaign, and returned to Berlin with a firm belief that there were too many unknowns about medieval leprosy in central Europe. Inspired both by what he had seen in Norway, and by the Scottish physician James Young Simpson’s archival work on leprosy in medieval England and Scotland published in 1841–​42,18 Virchow initiated a collaborative project on the history of medieval leprosy on the European Continent. He asked the readers of his medical journal for help gathering information on the following questions: what leprosaria existed, when they were erected, how many patients they admitted, what the conditions and rules for admission were, what forms of the disease were observed, and what causes were thought to be responsible.19 The questions were reprinted in several medical journals,20 and resulted in responses that were compiled into four lengthy articles based on replies from physicians and historians in Holland, Portugal, Russia, Finland, Greece, Switzerland and Germany.21 However, as Philip Kalisch has pointed out, while the resulting papers had extensive citations from original documents, showing a wide variety of responses ranging from religious rituals for the ‘living dead’ to the elaboration of rules and regulations regarding leprosy, there were no attempts at overarching synthesises of the material collected.22 The general picture remained that leprosy had been present in Europe since antiquity, and had increased sharply between the eleventh and thirteenth centuries, particularly after the crusades.23 From the fifteenth century onwards, with some differences from country to country, the disease had declined and was only left in remote pockets along the coast, such as in Norway, Greece and the Iberian Peninsula. The figures stating that France had at one point had 2,000 leprosaria and that 19,000 of these institutions existed in the Christian world as a whole were repeated, but this time without any scepticism.24 The numbers were used in various places to support the argument that immediate action had to be taken in the present situation. If not, the disease would proliferate and get out of control. From the 1870s, however, the relevance of medieval leprosy increasingly turned from fact-​gathering to interpretation, as more

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and more physicians started to question the validity of the depiction of a rise, peak and fall of medieval leprosy. According to August Hirsch (1817–​ 94), professor of medicine at the University of Berlin, the apparent increase between the eleventh and thirteenth centuries was not due to heightened prevalence, but was because an ‘increased scientific spirit’ in the medieval world had led physicians to take more notice of the disease.25 A similar argument, that the leprosaria made leprosy more visible, had been made some years earlier to defuse worries about an apparent dramatic increase in leprosy on Hawaii: The apparent rapid increase of leprosy began to be noticed, too, coincidentally in point of time with the establishment of the Queen’s Hospital and Dispensary, the number of lepers who applied for relief at the hospital augmenting year by year. The truth may be that the presence of the leprous amongst the population at large was only more clearly perceived on account of their seeking relief in greater number at the hospital as this became better known.26

Having debunked the idea that leprosy had increased, Hirsch questioned the notion that the disease later declined. The ‘decline’ of leprosy in medieval Europe was in fact due to more precise diagnosis, which caused the number of individuals diagnosed with leprosy to fall by the end of the fifteenth century.27 In other words, the earlier ‘peak’ was to a large extent due to misdiagnosis. While not everyone shared Hirsch’s interpretation, it illustrated the increasingly apparent problem with using medieval sources:  they could be interpreted in different ways to support a wide range of disease models. The relevance of medieval leprosy was further challenged by new techniques in medicine, in particular Gerhard Armauer Hansen’s argument that the disease was caused by a bacillus and was therefore contagious.28 Since the medieval medical authors had not had access to laboratory techniques and other diagnostic tools, it was increasingly difficult to present them as colleagues facing the same disease. In the perspective of contagion, the history of leprosy was rewritten into a grand narrative of a disease that since antiquity had spread around the world through time and space. In 1879, William Munro, late Medical Officer to Saint Kitts in the West Indies, argued that the disease had first occurred in Egypt,

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Africa, India or China, and dated the introduction to western Europe from Greece and the Middle East to early medieval times.29 Leprosy’s disappearance from medieval Europe, he argued, was a direct consequence of ‘lepers’ being kept strictly apart from the healthy. The disease was then introduced to the New World by the transatlantic slave trade. Similarly, leprosy was transported over the Pacific as a stowaway with the importation of Chinese labour to both Hawaii and Australia.30 While Munro did not mention the bacillus –​only that the disease was contagious –​the leprosy bacillus would fit hand-​in-​glove with the new narrative. The laboratory revolution in medicine was not the only reason why medieval leprosy lost relevance as a basis for policy advice. New genres for epidemiological studies based on patient registries were also important. When Hansen became head of the Norwegian leprosy apparatus in 1875, he re-​examined the national patient registry. Instead of looking for family connections, he compared districts that had different practices when it came to ‘evacuating’ those affected to the State leprosy institutions. His conclusion was that even partial segregation led to a reduction in new cases.31 When the annually updated registry was first established in 1856, there had been 2,874 cases in Norway; in 1874 the numbers had been reduced to 1,852. Although not everyone agreed with Hansen’s explanation, the records were considered more reliable and verifiable than scattered and uncertain medieval sources. As Hansen successfully argued for increasingly strict leprosy legislation in Norway in 1877 and 1885, medieval leprosy was given a new meaning. To Danielssen and Boeck, the medieval practices had been a warning that a belief in contagion led to cruelty. This had entailed a selective interpretation of the medieval texts, highlighting the coercion and brutality under which ‘lepers’ had been treated. Hansen had a different perspective, firmly believing that the image of strict medieval segregation was proof that the policies of the past had succeeded in reducing the number of cases. At the same time, however, by presenting medieval segregation practices as abusive, the ‘modern’ approach to segregation was put in a favourable light. Echoing the same argument, Alexandre Kermogant, from 1906 Inspector General of the French colonial health services, argued that increased travelling made leprosy in the colonies a growing

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threat to the colonisers, and that the solution was ‘modern leprosy sanatoriums or nursing homes’: We have noted the danger and it is growing every day following the expansion of all colonial peoples, the growing number of relationships with other countries, and facilities provided to passengers to travel the world. In these circumstances would it not be prudent to consider, not the leper colony –​that would be medieval –​but sanatoriums or nursing homes to isolate lepers who come to us from beyond the sea … Remember, in any case, nothing is more dangerous than the failure of any prophylactic measure vis-​à-​vis a scourge that threatens us. Caveant consules!32

The last major study of medieval leprosy in the nineteenth century was conducted under the auspices of the British National Leprosy Fund, the trustees of which, in 1895, published the winning contributions to their essay competition on ‘Conditions under which leprosy has declined’. From a comparative study of diet and sanitary conditions in medieval Britain and contemporary China, India and Iceland –​places where the disease still existed –​ the British physician George Newman concluded that the rise and fall of medieval leprosy in Europe boiled down to changes in diet and lifestyle. ‘The whole weight of historic evidence is opposed to the supposition that contagion was the cause of the spread of the disease, and that segregation was therefore the cause of its decline.’33 Instead, famine and plague, by significantly reducing the population in medieval Europe, led to marked improvements in social and hygienic conditions. Furthermore, he suggested that segregation of those affected had never been total, and could therefore not be part of the explanation of the decline in cases.34 Thus, he concluded: The disease being diffused neither by contagion nor heredity, has under favourable hygienic circumstances a tendency to die out. Hence, the decline and final extinction of endemic leprosy was due, not to segregation, but to this general tendency under favouring circumstances, viz. to a general and extensive social improvement in the life of the people, to a complete change in the poor and insufficient diet … and to agricultural advancement, improved sanitation and land drainage.35

Newman’s Danish co-​winner Edvard Ehlers, however, basing his argument on documents from Iceland, argued that the disease had

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been prevalent in medieval times, but had declined in the eighteenth and nineteenth centuries because of ‘popular dread of contagion’. The main support for the theory was that after the leprosaria in Iceland were closed in 1848, the prevalence of leprosy increased once more: Surely the hospitals played but a slight part in the combat against the disease, but it must not be left out of consideration that their existence indicated that the disease was still to be feared. On the contrary, the abolishing of the hospitals and the administration’s throwing up the game could not help giving the population the idea, which Iceland’s superior physicians persistently maintained, that the disease was on the point of becoming extinct spontaneously, and that it no longer deserved any interest.36

The studies of Newman and Ehlers illustrate the tendencies in the medical debate on medieval leprosy at the end of the nineteenth century to tailor strategies, arguments and conclusions to specific disease models and policy recommendations that were then current. For those, like Newman, arguing that leprosy was caused by poor diet and insanitary conditions, the sanitary improvements in late medieval Europe both explained the past and gave a mandate for policies in the colonies in the present. This rationale had a strong support base in Britain, which only had a handful of cases at home, but possibly hundreds of thousands of individuals affected in the colonies. For those arguing that the disease was contagious, like Ehlers, the key to the decline of medieval leprosy was segregation, and this solution was equally valid in the present. This line of reasoning was especially strong in Scandinavia and other countries where the disease was ‘home-​grown’, and from the 1880s it became increasingly entangled with the disease model that claimed that leprosy had a bacteriological origin. As the bacteriological disease model started to gain hegemony around 1900, particularly with the establishment of the journal Lepra bibliotheca internationalis with Ehlers as the main editor, references to medieval leprosy were more or less limited to those sceptical of the new paradigm.37 The British physician Jonathan Hutchinson, who repeatedly stressed that the disease had disappeared despite segregation never having been complete, pointed at foodstuffs (badly cured fish) as the original culprit in the Middle Ages.38 Zambaco

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Pacha, one of the last champions of a hereditary disease model, likewise criticised contemporary segregation for being ‘medieval’, meaning too strict and inhumane.39 In the decades that followed, medieval leprosy lost its relevance to most medical discussions. In monographs on the disease, its medieval impact remained part of the historical account, but only in order to connect earlier occurrences with the present situation. For physicians, reinterpretations of medieval leprosy were now based on backdating new insights into the aetiology of the disease, not on revisiting the medieval sources.40

Imperial perspectives on medieval leprosy In the nineteenth century, medical professionals were not the only individuals looking to medieval history to inform perceptions of leprosy in the present. Leprosy seized Europeans’ attention:  with the expansion of empires, Europeans came into contact with greater numbers of people affected by the condition. In 1889, a ‘leper scare’ swept across Europe, and fears about the possible resurgence of leprosy prompted people to seek answers about why the disease had declined in the Middle Ages, in hope of finding reassurance and potential solutions with regard to the situation that faced them in their own present. The spectre of empire loomed in almost all discussions and studies of leprosy in the nineteenth and early twentieth century, and some more recent debates over the history of medieval leprosy still reflect the legacy of an imperial past.41 Generally speaking, leprosy had disappeared from western Europe by the end of the eighteenth century, and as such was considered a disease of the past. But when Europeans began encountering leprosy again in the nineteenth century, both in their colonies abroad and in small numbers at home, they needed to reconcile the leprosy of Europe’s past with the present, especially because the disease afflicted the ‘primitive’ peoples of the tropics. Writers and medical practitioners sought explanations for the spread and decline of leprosy that drew parallels between medieval Europe and the contemporary tropics, while differentiating both settings from modern Europe. Colonisers branded leprosy as a tropical disease, thus distancing themselves from their own epidemiological

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past, because of the special threat that leprosy, as a disease of the ‘primitive’, posed to the civilised identity of Europe. In Britain, as in other countries, diseases of the tropics posed a special threat to ‘civilisation’ and the national psyche. The word ‘civilisation’ was repeated frequently in British writings, as though it was a safeguard against disease, indicating the deep anxiety with which British people perceived the world that commerce and imperialism had brought to their doorstep.42 European interest in leprosy rose dramatically in 1889 when Father Damien, a Belgian Catholic missionary, died with leprosy at the Molokai leprosy settlement in Hawaii. News of Father Damien’s death on 15 April that year spread rapidly across the globe; photographs of him on his deathbed sold by the thousands in London, and one photo displayed in a shop window in Birmingham caused such a crowd that police were called to clear the streets.43 Upon his death, the priest was an immediate sensation, drawing ‘the gaze of the world’ to the issue of leprosy.44 For the next three months, newspapers teemed with articles about the spread of leprosy, for in his death, Father Damien was perceived as a role model for the charity and compassion due to leprosy victims; as evidence of the contagiousness of leprosy and the possibility that white Europeans could be infected with it; and as a reminder that medical practitioners still knew little about the causes and treatment of the disease. Father Damien’s death, in drawing the attention of the media and thus the public to the issue of leprosy, lent credence to a small body of alarmist literature warning that, because of colonial expansion, leprosy was once more a threat to Europe. Agnes Lambert, who wrote extended articles about leprosy for the literary magazine The Nineteenth Century, was one of the earlier voices in the popular press proclaiming Britain’s vulnerability to leprosy, which ‘has not ceased to be of living interest and concern to Englishmen; that, with the expansion of England, it has been brought back to our very doors’.45 Archdeacon Henry Press Wright was far more outspoken in voicing his fears regarding leprosy: He is a craven creature who is afraid to speak out boldly, when he believes that there is a cause for warning against a threatening trouble … All this applies particularly to leprosy, and to those who

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declare that the disease is greatly on the increase; and thus, unless due precautions be taken, it will … become again, and that speedily, a common scourge throughout Europe.46

Sir Morrell Mackenzie, a physician whose voice joined Wright’s, supposed that ‘most people, I  imagine, were till lately in blissful ignorance of the fact that leprosy still walks the earth in all its original hideousness’.47 These individuals, doctors and laypeople alike, felt that leprosy was a present and grave threat to the ‘civilised’ world, and wrote books, articles and letters to newspapers to warn others that colonialism and commerce meant that leprosy was no longer a disease of the past to which Europe was now invulnerable.48 These publications were part of a wider trend in which topics in science and medicine were introduced to the public via the popular press, and through periodicals in particular,49 though as one doctor wrote:  ‘As for leprosy in England, we certainly do not share the alarm of Archdeacon Wright, and still less do we consider sensational newspaper articles on the subject justified.’50 Many of those who were caught up in the ‘leper scare’ believed that the best means of controlling the threat of leprosy was to isolate its sufferers, and they looked to medieval history –​and in particular the histories written by contagionist leprologists –​for evidence that segregation was the key factor that had led to leprosy’s decline in Europe. It was ‘thanks to measures of strict isolation adopted during the middle ages, [that] leprosy began to decrease in Europe’, and if ‘[l]‌eprosy has ceased to exist in some lands; what was done there with such success can it not be done again?’51 In an article in The Nineteenth Century, Dr Mackenzie went so far as to suggest that those who believed that leprosy was not contagious and advocated against segregation were to blame for the purported return of the disease: The whole system of medical police by which leprosy was finally driven out of Europe was based on the notion that it was contagious, and no measures not based on that principle have ever had the slightest effect in checking its ravages. The alarming spread of this loathsome pest in recent years is in my opinion due to the fact that for some time the opposite doctrine gained the ascendency, and held captive the minds of men.52

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Leprosy was ‘the great disease of mediaeval Christendom’, and histories of medieval leprosy abounded with descriptions of the harsh treatment of medieval sufferers.53 ‘Harshly, indiscriminately, and imperfectly as was this separation carried out in those dark days’, it was nevertheless considered primarily responsible for leprosy’s decline, and as the prolifically alarmist Archdeacon Wright wrote, ‘What was done in darker times can surely be done in these bright days of advanced science.’54 Initially, the segregation of leprosy patients in medieval Europe was mobilised as evidence to support contagionist theories of the disease’s spread, and as a theory of how to bring about its decline. As European fears of its resurgence heightened during the ‘leper scare’, a belief that medieval ‘lepers’ had been totally isolated became a means of assuaging that fear. The narrative about the decline of leprosy in Europe’s past was deeply comforting. If segregation was imposed in the present, this would protect Europeans from the terrifying possibility of a widespread recurrence of leprosy. One of the debates over medieval leprosy, which preoccupied medical practitioners and laypeople alike, was what had led to its decline. Many attributed that decline to the supposed isolation of leprosy patients in medieval Europe. The segregation of leprosy sufferers was thus championed by many, especially in the late nineteenth century by those medical professionals who argued for leprosy’s contagiousness, and by those in the midst of the ‘leper scare’ who believed that seclusion was ‘the only sure means of really coping with the greatest and most mysterious of the maladies that afflict mankind’.55 The other major rationale for leprosy’s progressive decline between the late Middle Ages and the end of the early modern period was Europe’s advancing civilisation, which involved improved nutrition, hygiene and sanitation, and less overcrowding. This argument was generally promoted by anti-​contagionists, who argued that the segregation of leprosy-​ affected people had never been absolute.56 By the late nineteenth century, most medical professionals writing on the history of medieval leprosy at least included advancing civilisation alongside segregation in their explanations for the disease’s decline, though they often privileged the importance of segregation:

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The fact remains that cases of leprosy became less and less frequent in Europe in the fifteenth and sixteenth centuries, and that the decline of the disease was in proportion to the rigour with which isolation was enforced upon the sufferers. Other causes, doubtless, co-​operated in producing the effect. During the middle ages, and even at a much later date in some countries in Europe, the articles of food consumed by the people in general were for the most of an unwholesome and innutritious character … The habitations and surroundings of the people presented many conditions in the highest degree favourable to the spread of epidemics; water was generally scarce and often bad; the arrangements for the disposal of excreta were of the rudest character. Slowly, but surely, a progressive improvement took place in many respects. The food of the poorer classes became more varied, more abundant, and more nutritious in character, and some advance was made in the art of cookery; while, owing to the increasing spread of commerce with other countries, bad harvests were no longer followed by wide-​spread famine. Social conditions in general were thus rendered much more favourable than at any previous time, and it is highly probable that the disappearance of leprosy was in some measure due to the improvements thus briefly specified. The isolation of the sick was, however, the most potent factor.57

It was not until the 1920s that the balance began to shift in favour of advancing civilisation, over segregation, as the main explanation for leprosy’s decline. As the British leprologists Leonard Rogers and Ernest Muir argued: Enforced residence of the few infective cases outside a town or village must have played some part in the reduction of new infections. On the other hand, compulsory powers, even yet, often fail to discover and isolate cases before they give rise to new infections, and would scarcely have been more effective in early days … The end of the fifteenth and the beginning of the sixteenth century marked the end of the Dark Ages … Moreover, a general improvement in the conditions of living … was doubtless an important factor in reducing the over-​ crowding so favourable to … infection. That a high degree of civilization is inimical to the spread of leprosy is indicated by the practical absence of infection from imported cases in Great Britain, France and the temperate areas of the northern United States of America.58

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Many leprologists agreed that ‘the history of [leprosy’s] prevalence, increase, and decline in different regions of our globe, is interwoven with that of civilisation itself’.59 Rogers and Muir had many reasons, practical and ideological, for emphasising civilisation over compulsory segregation. The British Empire reached its height in the interwar period, and leprosy humanitarianism experienced growth as a secular, imperial endeavour, though it still continued to flourish as a missionary one. In the 1920s, Rogers and Muir were involved in the founding of the British Empire Leprosy Relief Association (BELRA), and across the British Empire  –​and other European empires  –​hundreds of new leprosy settlements were founded in the 1920s and 1930s. Some experimented with the compulsory segregation of leprosy patients, but segregation on such a scale proved impracticable. The incidence of leprosy could not be decreased unless the disease’s sufferers could be separated from others during the period that they were infectious, and most colonial medical authorities found this kind of segregation ‘impossible’ and undesirable.60 It required a staggering amount of financial resource, and Rogers and Muir argued that compulsion was the worst way to effectively control the spread of leprosy, as it often pushed leprosy sufferers into hiding, where they could continue to spread the disease.61 Leprosy settlements that patients could be persuaded to enter voluntarily were a more ideal solution, not least because as residential, relatively segregated facilities they offered missionaries, charities and colonial governments an opportunity to attempt to engineer ‘civilised’ communities that integrated ‘traditional’ customs with aspects of ‘civilisation’ and modernity that Europeans found desirable.62 This ‘civilising’ mission was an important justification for colonialism and missionary work, and was premised upon the idea that Europeans (especially the British and French) were inherently superior to the people of the tropics, and that it was therefore their right and responsibility to promote those traits that defined the ideal citizen, for the benefit of their ‘primitive’ colonial subjects.63 The emphasis on segregating patients in colonial leprosy settlements for this purpose is all the more notable given that, in practice, these settlements were too expensive to reach all infectious leprosy patients.64 As leprosy specialists began to perceive compulsory segregation as a less

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effective tool for controlling leprosy, and the imperial, ‘civilising’ endeavour of leprosy control expanded, doctors such as Rogers and Muir began to alter the way in which they wrote about medieval leprosy. In order to heighten the contrast between medieval and modern Europe, many writers emphasised the poor and unhygienic living conditions of the Middle Ages, and then compared those medieval conditions to life in the tropical colonies, thus underlining the distinction between ‘civilised’ modern Europeans and the ‘primitive’ colonised. Doctors and historians writing about leprosy co-​opted some particularly colourful descriptions of life in medieval Europe:  ‘The sediment of the town population in the Middle Ages was a dense slough of stagnant misery, squalor, famine, loathsome disease and dull despair such as the worst slums of London, Liverpool, or Paris know nothing of.’65 ‘The Normans did not bathe and wash as much as the Saxons, they lived in close unventilated hovels, the diet was poor, and shameful intemperance and immorality prevailed extensively.’66 For the most part, European leprosy specialists and missionaries in the twentieth century made no link between leprosy and immorality or sexuality –​instead they linked leprosy in the colonies to lack of hygiene and civilisation.67 However, missionary and Government belief in the ‘primitive’ immorality of colonial subjects, especially in Africa, certainly did influence their perception of disease across the Empire, and the desire to distance Europe’s medieval past from the colonial present.68 Leprosy was considered to be ‘a consequence of the filthiness of our ancestors. People never washed in the Middle Ages; therefore leprosy was the result of a spontaneous generation in the dung-​ hill on which society was rotting.’69 ‘This disease, which one almost considers as prehistoric, can strike root … where Hansen’s bacillus refinds its favourite soil of uncleanliness, bad nourishment, and filthiness, under hygienic circumstances which have not altered in many respects since the Middle Ages.’70 Such sensational statements were meant to reinforce the conviction that leprosy afflicted ‘primitive’ races that lived in filth and ignorance; ‘civilised’ individuals were clean, moral and knowledgeable enough about hygiene to be insusceptible to leprosy. European society as a whole had progressed beyond the point of danger, for leprosy was a disease of the ‘uncivilised’.71

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The desire to differentiate nineteenth-​and twentieth-​ century Europe from medieval Europe and the tropics was so strong that when leprosy was encountered in modern Europe, the contradiction was resolved by ascribing primitive characteristics to those Europeans who contracted the disease. Within Europe, leprosy was thought to be most prominent in Norway, and one doctor wrote of Norway that: The peasants of that country are unspeakably dirty. Most of them never take a bath; and only once a week wash their face and hands, their feet once a year, their body remains untouched by water from birth till death. Their clothes are generally of wool, and they never take them off in going to sleep; they are never washed, and these same clothes, as long as they are not absolutely rotten, are transmitted from generation to generation. Norway is the ‘classical land of leprosy’.72

Other Europeans, anxious to dissociate themselves from the disease’s presence close to home, branded Norwegians as economically backward, primitive, and therefore the ‘classic’ victims of leprosy. The British in particular were able to remain comfortable in their conviction that any leprosy that lingered in Europe was a relic of a primitive past, whereas in their colonies, leprosy was a contemporary problem that assailed societies that seemed centuries behind Europeans. The contrast between ‘civilised’ modern Europe and its ‘primitive’ medieval past was part of an attempt to preserve the superior and ‘civilised’ identity of European nations, which served as a partial justification for the colonisation of the ‘primitive’ peoples of the tropics. Imperialism was justified with the argument that colonisers were providing the colonised with services and opportunities that they could not otherwise provide for themselves. The fundraising propaganda of BELRA stated that ‘It is a patriotic duty to try and make every part of the Empire as healthy as possible’, and its aim was to ‘arouse the public conscience’ to this responsibility.73 Leprosy was ‘overshadowing the fairest spots of earth and the most fruitful territories of our commonwealth’.74 Incorrectly assuming that leprosy sufferers were universally stigmatised, colonisers believed that in providing care for leprosy patients they were offering a relief from stigma, and a medical service that their colonial subjects could not have provided for themselves –​if they stayed on colonial soil.

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Leprosy sufferers supposedly had even more reason to be grateful for their colonisation than the colonisers themselves, as Agnes Lambert commented in 1884 in relation to the recent addition of Cyprus to the British Empire:  ‘Whatever Englishmen may have felt and feel about it, the leper at least is thankful that Cyprus has become part of the British Empire.’75 Moreover, Europeans could gradually ‘civilise’ their colonial subjects, until they too reached the standards of living in modern Europe that had caused leprosy to disappear. In 1930, Joseph Attard, a native of Malta, was admitted to the Infectious Diseases Hospital in Cardiff, shortly after his immigration to Great Britain. For the next four years there were various attempts to repatriate Attard, as evidenced by two large files in the British National Archives full of letters between various hospital and Government authorities, each attempting to avoid the expense and inconvenience of Attard’s presence. No one wished to care for Attard, for as his attending physician at the ‘Saint Giles Home for Lepers’ (see below), where he was eventually moved, wrote, he was ‘not a satisfactory patient. He is of a different type and race to the others … He is a Maltese; it seems illogical that he should remain here.’76 In spite of their best efforts, however, attempts to deport Attard were ultimately unsuccessful because there was no law that could force him, as a British subject, to leave the country unwillingly.77 Attard is a rare example of leprosy entering Britain in the body of a colonial subject, and an unwelcome one, for it was much preferable to practise love and charity towards leprosy patients in the Empire, where colonial subjects could be gradually ‘civilised’ until they too reached the standards of living in modern Europe that had caused leprosy to disappear, than at home. The great fear of leprosy in Britain was linked to a supposedly medieval prejudice against it.78 Several cases involving leprosy ended up in British courts, the most publicly documented being a suit in which Mr Humphreys, a lodging-​house keeper, claimed damages against the relations and doctor of Mr Miller, a deceased man with leprosy who had lodged in Mr Humphreys’s house, for alleged breach of warranty, fraudulent misrepresentation and conspiracy. Humphreys asserted that all three parties knowingly concealed Mr Miller’s diagnosis of leprosy, and in so doing breached the warranty that Mr Miller was fit to occupy lodgings. Further, Humphreys claimed not only that his family had been put in danger by residing

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in the same house as a leprosy patient, but also that once it was discovered that a ‘leper’ had resided in his lodging house, it was impossible for him to let any of the rooms. He had been forced to destroy all of the furniture in Mr Miller’s room and repaper the walls, for such was the dread of leprosy that, even after the man’s death, no one would enter the room for fear of contagion.79 Sir Leonard Rogers, leprologist, attributed these cases of prejudice to the Middle Ages: To progress in dealing with this dread disease by the ignorant prejudice of medical as well as laymen, chiefly due to the extraordinary survival from the Middle Ages of utterly false ideas of the great contagiousness of leprosy, such as quite recently led to the flight from an American court of justice, on the appearance of a leper in it, of nearly all those present, including the ‘judicial ermine’ …80

In the case against Mr Miller’s estate, even when presented with clear evidence from medical experts of leprosy’s negligible contagion in England, and warned not to fall under the sway of long-​popular prejudice towards the disease, the jury could not overcome their conviction that leprosy was contagious and dangerous, and the judge had to overrule the jury’s guilty verdict.81 The need to differentiate ‘modern’ Europe from its ‘primitive’ colonies and medieval past also affected nineteenth-​century debates over the incidence of leprosy in medieval Europe, as discussed in the previous section, and over whether leprosy had been a disease only of medieval peasantry, or also of royalty. Authors of leprosy history, whether medical professionals or historians, initially based their estimates of the number of leprosy sufferers upon the number of ‘leper’ hospitals that they believed to have existed. While some were happy to repeat Matthew Paris’s medieval estimate of 19,000 leprosaria in Europe, others claimed it was an over-​estimate based on a mistranslation, and even posited that the incidence of leprosy in the Middle Ages had been quite low, and that ‘the high figures often given for the number of leprosy houses is attributable mainly to the misguided enthusiasm of romantic historians of modern times’.82 A  few even argued that ‘the extent and importance of the disease were exaggerated out of measure by ecclesiastical example and precept’ in the Middle Ages, and were guided by ‘religious fervour’ and ‘extravagances’, ‘misunderstanding’ and

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‘exaggeration’.83 These historiographical debates had implications beyond the medical. Some were at pains to point out that the incidence of leprosy in medieval Europe was not higher than its incidence in the contemporary, colonial world. In order to preserve imperial Europe’s ‘civilised’ identity, it was important that Europe’s more ‘primitive’ ancestors be no more prone to leprosy than the colonised denizens of the tropical world.84 The implication was that the ‘romantic’ historians who emphasised great numbers of leprosaria and, by extension, of people with leprosy, were influenced by a desire, medieval and contemporary, to aggrandise the medieval religious and philanthropic tradition of healing the leprosy sufferer.

Philanthropic perspectives on medieval leprosy Leprosy has long been a disease of contradictions, and while modern Europeans were casting medieval Europeans in a negative light to suit their own medical, social and political agendas, they were also looking to their medieval ancestors for positive inspiration to philanthropy. Many of the same authors who wrote about the isolation, stigmatisation and cruel treatment of leprosy sufferers in medieval Europe also wrote about the religious calling of people with leprosy and the philanthropy that was directed towards them. As Agnes Lambert wrote, ‘The history of leprosy touches the loftiest heights of heroic self-​denial and generosity; it goes down into the lowest depths of the most pitiful selfishness and brutal cruelty and greed of which the heart of man is capable.’85 Some authors resolved this disparity by blaming the cruel treatment of medieval leprosy sufferers on secular authorities and human nature, which the Church sought to counteract: Whilst the civil power, animated by a selfish fear of contagion and infection, accomplished little with its stern measures of repressive legislation, the Church, without running counter to what was sound in the principle of such measures, mercifully legislated for the well-​ being of the whole community … and with the true instinct of charity inspired the kings and queens, the bishops, nobles, and burgesses in the middle ages, who founded or endowed hospitals throughout the land for the shelter and seclusion of the leper.86

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Casting the Church and charitable nobility as the counter-​actors of a cruel populace and Government allowed modern historians to paint a picture of the humane segregation of leprosy sufferers, which was particularly important to those authors who advocated segregation as the best means of controlling leprosy. It created the possibility of the argument that ‘segregation if properly carried out, is the best thing for the sufferers themselves’.87 Christianity, specifically Christ’s call to ‘cleanse the lepers’, was one of the most important motivations to leprosy philanthropy in modern Europe, as it had been in the Middle Ages, and in writing about the Church’s history of care towards leprosy sufferers, non-​medical authors in particular were celebrating a history of Christian philanthropy to leprosy, and suggesting a repetition of the same endeavours.88 It was argued that leprosy patients need not be segregated only out of fear of their contagion:  if donors supported leprosy sufferers in their isolation it could be a humane and charitable repetition of the medieval Church’s successful charity. Archdeacon Wright, who wrote so alarmingly about the return of leprosy to the civilised world in the midst of the ‘leper scare’, wrote that ‘Lepers in the middle ages were on the whole duly protected and comforted. And great was the reward, for it was that wise and generous provision for the afflicted which by degrees removed a foul and torturing disease from our own and other lands.’89 The Revd Mulhane, who wrote a contemporaneous volume on Leprosy and the Charity of the Church, credited the inception of Christianity with the inception of organisations to care for unfortunate leprosy sufferers.90 He agreed with Wright’s statement that: It is commonly supposed that leprosy died out, expended itself; that it came no one knew how and went away no one knew why. Better far to say gratefully that our present freedom from the greatest and oldest scourge of man is chiefly due to the Church, especially to its Christ-​loving fraternities, which while they carefully supplied bodily and spiritual wants to the leper, kept him strictly within certain limits well apart from the strong and healthy. It was this close segregation that removed leprosy from our midst.91

One of the fraternities to which he referred was the Order of Lazarus, a knights’ order for leprosy sufferers alone, and of this time and order Mulhane exclaimed: ‘Glorious age of Christianity! What power! What sacrifice’.92

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This ‘humane segregation’ was enacted through the creation of model leprosy settlements. These colonial settlements were often organised as ‘model villages’, carefully designed to reflect the colonial vision for a ‘civilised’ world, from the site, layout and construction of the settlements and their buildings, to the social, political and economic organisation and facilities that were provided for residents.93 To a certain extent these ‘civilising’ goals were shared by the missionaries, Government officials and charities who cooperated to maintain colonial leprosy settlements, but the religious traditions of philanthropy and care for people affected by leprosy that so strongly influenced missionaries sometimes put them in conflict with the colonial Government. For example, in the British protectorate of Uganda, missionaries tended to prioritise the admission of patients in the more advanced, debilitated stage of the disease, rather than patients in the infectious, early stages. The colonial Government –​echoing the opinion of leprologists –​wanted missionaries to admit ‘infectious cases and active cases likely to be benefitted by skilled anti-​leprosy treatment’.94 Their perspective on ‘benefit’ was a model of in-​patient treatment for infectious patients to be segregated early to reduce the contagion of leprosy; for debility to be prevented; and for discharge to take place in a matter of years, rather than decades, so that more space would be available for new patients.95 For missionaries, healing leprosy patients was about much more, for ‘God gives a special compensation and consolation to those who suffer’, and none suffered more than the person affected by leprosy.96 People with leprosy were capable of a relationship with God to which missionaries could only aspire, and the greater their suffering, the greater the value of their conversion to Christianity.97 It is hardly surprising, then, that missionaries were particularly inclined to admit patients whose suffering they perceived as greatest. Physical suffering was characterised by one missionary as: Poor little bodies maimed and legs doubled under … [An] old woman … literally smothered from head to foot in large patches of leprosy. Another woman, with her poor old face eaten away … I am afraid that there are some people elsewhere who think that it is much nicer to treat the acute sufferers, who quickly respond to treatment, in preference to these poor creatures.98

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Drawing on the Old Testament, their understandings of medieval leprosy and their own senses, missionaries firmly believed that leprosy was and always had been universally stigmatised, and thus people affected by leprosy also suffered emotionally.99 These sentiments were also echoed in popular culture and fundraising literature for leprosy, and donors tended to share the missions’ priorities.100 The missions were reliant on these donors, and colonial governments, for funding; as in other areas of colonial medicine, missionaries were the dominant providers of healthcare before the Second World War. For many of the missionaries who devoted their lives to leprosy work, the example of medieval saints was just as important to inspiring their religious calling as the desire to follow in Christ’s footsteps. Saint Francis of Assisi, in particular, was an exemplar for many Catholic missionaries, and even for the formation of Britain’s Catholic leprosy charity, the Saint Francis Leprosy Guild. In East Africa, a number of leprosy settlements were founded and run by the Franciscan Missionary Sisters for Africa (FMSA). When the FMSA missionaries wrote of a role model for compassion and love towards the leprosy sufferer, they usually pointed to Saint Francis. One of Francis’s many recorded attributes was his compassion towards people with leprosy. His hagiographers wrote of his Christ-​like ability to transcend his physical abhorrence of the leprosy sufferer’s disfigured condition in order to kiss or embrace the ‘leper’.101 In overcoming his revulsion to embrace the leprosy sufferer, Francis was re-​enacting Christ’s love for those affected by leprosy and symbolically embracing Christ himself.102 Mother Kevin, the founder of the FMSA and of two leprosy settlements in Uganda, wrote that leprosy work ‘is our Franciscan Heritage’, and the FMSA missionaries who followed in her footsteps added that ‘we also felt proud that Our Lord had chosen us to be His instruments in fostering this work of charity so dear to the heart of Our Holy Father, St. Francis’.103 Saint Francis’s modern-​day counterpart in heroic self-​sacrifice for the salvation of the leprosy sufferer was Father Damien, whose contraction of leprosy and following death ignited the ‘leper scare’.104 Even before his death, Father Damien was cast in the popular and medical press as a heroic martyr. Agnes Lambert wrote in The Times that: ‘One heroic priest after another has cut himself

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off from his kindred and all that makes life glad, in order to devote himself to their service … But at last he has himself fallen a victim of the terrible disease.’105 Months before his death, the British Medical Journal reported that: Father Damien will soon be no more, as he is falling a victim to his charity. ‘In England and America’, writes his devoted colleague at Molokai, ‘they call him the Hero Martyr … If you could only seem him as he lies, in his room, on the floor, upon his bed of suffering … People call it a sacrifice to live with lepers; but, only on seeing oneself a leper, and nothing but lepers around, then only does the extent of the sacrifice become apparent … The unfortunate priest … in the pursuit of the duties of his high calling, is suffering a martyrdom beyond comparison more cruel than any that befell the martyrs of the early Church.’106

‘The heroic sufferer in the leper isle of Molokai closed his life of self-​ denial and devotion’, and the ‘noblest of Christian heroes’ became an inspiration for self-​sacrifice for the salvation of leprosy sufferers, whether through donations or mission.107 Even ‘the least among us’ could follow his example and ‘help to give some little solace to the sad lives of the doomed exiles of Molokai’.108 There were calls to ‘take a humble advantage of the momentary romantic grief … [to] effectually stamp out this curse from off the face of the earth’, and charities in Father Damien’s name were founded across Europe.109 In the years following his death, ‘Heroism and self-​ sacrifice in the interest of humanity, like that displayed by the brave Father Damien, are, happily for the human race, by no means of unusual occurrence.’110 In fact it was a far more usual occurrence that women, rather than men, volunteered as missionaries to leprosy-​ affected people, and quite a number did contract the disease, but these women’s sacrifices were hardly ever mentioned in the popular or medical press. One of the reasons that Europeans were so ready to admire Father Damien was because his life –​and death –​in Hawaii was so remote that it never posed a risk or a threat to them.111 While his death did raise fears of leprosy’s contagion and potential return to Europe, some medical professionals pointed out that Father Damien and Sir George Turner, the Europeans best known for contracting leprosy, ‘BOTH were known to be notoriously careless, not washing after handling lepers, and it is most significant that

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although four of the brotherhood contracted the disease in Hawaii, not one of the nursing sisters handling and dressing the lepers, but trained in cleanly methods, got leprosy.’112 Father Damien had, quite literally, sacrificed himself in the name of God. A sonnet appeared in the Jesuit magazine The Month, and an excerpt from that sonnet indicates the martyr’s role in which Father Damien was cast: Dead, say they? of thine own sweet accord, Who thro’ long years a dying life didst lead … Oh, lepers’ friend, who didst—​’twas all they care—​ Nurse their vile bodies and their souls make fair, Them loving for dear love sake of they Lord. Hero and martyr, of that glorious band Of saints immortal, where few greater are, For greater love than thine, sufferance more grand, Few mortals proved …113

In some senses, Father Damien was following in the footsteps of medieval holy men and women who asked to be given leprosy, so that through their suffering they might assure the redemption of others.114 Europeans were not nearly so loving and charitable when it came to other Europeans whose contraction of leprosy was not a result of their heroic dedication to the salvation of leprosy sufferers, and who brought their infection back to Europe with them. In the 1940s, one doctor proposed that Britons who had acquired leprosy in the colonies would be best suited to entering a leprosy settlement exclusively for whites in Southern Rhodesia (now Zimbabwe).115 Britain’s first home for leprosy-​ affected people in centuries was opened in 1914, after many years of difficulties  –​not least in raising funds from philanthropists. The founders of the ‘Saint Giles Home for Lepers’ were unwilling to make a public appeal, lest it attract too much publicity and, more alarmingly, patients from other countries.116 When the Daily Chronicle published the first news of the opening of Saint Giles in June 1914, the founders were considerably annoyed, having gone to great effort to keep the nature of the Saint Giles Home a secret from the community.117 The plans submitted to the Chelmsford Rural Council were described as ‘plans of cottages and homes for chronic invalids’, without mention of leprosy, and were passed as such.118 The Home’s first patients

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were snuck in ‘under the cover of night to avoid creating alarm among the local residents’, and the County Medical Officer was asked to use his influence to ‘keep the whole thing quiet’.119 The founders were right to be so wary; far from welcoming these men and women with Christian charity, the local community expressed ‘great horror and indignation’.120 A local Parish meeting was held in protest, and in the following weeks the issue was brought up at meetings of the Essex County Council and other local parishes, and in the local newspapers. Having leprosy-​affected people ‘planted in their midst’ as ‘un fait accompli’ suggested to the local community that they were living under an ‘official tyranny’, betrayed by those Government officials who should have protected them. Fears of leprosy contagion aside –​though they were strongly felt  –​‘the fact remained that the popular idea was still strong that such an institution should be entirely isolated at sea … If the institution remained there the property immediately adjoining it must deteriorate in value and the owners of it would suffer heavy pecuniary losses.’121 Although a number of protestors professed sympathy for ‘those who were trying to do good and minimise the suffering of their fellow creatures who were afflicted with an odious disease’,122 they considered the welfare of the county more important, and had ‘no burning desire to be known in the future as the Home for Lepers in England!’123 The public recognised the contradiction inherent in their perception of leprosy at home and abroad, but while charity was laudable when leprosy was a distant danger, compassion was unthinkable when that danger was local.

Conclusion Physicians, philanthropists and writers in the popular press in the nineteenth and early twentieth century were preoccupied with the impact of leprosy in medieval Europe for a number of reasons. As the disease was encountered in the colonies and in certain parts of contemporary Europe, information was sought about the prevalence of leprosy in medieval Europe and why it had ultimately largely disappeared. This material was used to shape policy regarding the disease in those European countries still affected, such as Norway and Iceland, although it became less relevant to medical and policy

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discussions after the advent of germ theory. Information about medieval leprosy was also deployed to justify the colonial endeavour, which offered care to leprosy sufferers and, it was believed, would ultimately eradicate the disease by ‘civilising’ the colonised. At the same time, the medieval example of Christian charity towards the leprous motivated Christian missionaries in the colonies, and was understood to have brought about the elimination of leprosy in the Middle Ages through the humane segregation that it entailed. Doctors, scientists, philanthropists and journalists reshaped the past, in search of answers and in search of fodder to justify their attempts to control people of colour, whom they perceived as lesser than themselves, even as that control was cast as a humanitarian and philanthropic endeavour. While the agency and resourcefulness of nineteenth-​and twentieth-​century leprosy patients meant that in leprosy settlements Europeans had to negotiate rather than control, it is worth remembering that the ways in which medieval histories of leprosy were written, and continue to be understood by people today, are part of a troubling imperial legacy.124

Notes 1 See the Introduction to this volume, p. 1. 2 There are two notable exceptions:  P. A. Kalisch, ‘An overview of research on the history of leprosy. Part  1. From Celsus to Simpson, Circa. 1.  A.D. Part  2. From Virchow to Møller-​Christensen, 1845–​ 1973’, International Journal of Leprosy, 43(2) (1975), 129–​44. On nineteenth-​and early-​ twentieth-​ century perspectives on medieval leprosy, see also Rawcliffe, Leprosy, Chapter 1. 3 See the Introduction to this volume, pp. 4–​5. 4 D. C. Danielssen and C. W. Boeck, Om spedalskhed (Christiania: Chr. Gröndahl, 1847). The monograph was translated into French in 1848 with the title Traité de la spedalskhed ou éléphantiasis des Grecs. A  British summary by Erasmus Wilson was published as a series of eight articles in the Lancet in 1856 under the title ‘On the nature and treatment of leprosy’. R. Edmond, Leprosy and Empire: A Medical and Cultural History (Cambridge: Cambridge University Press, 2006), p. 46. 5 O. K. Skinsnes, ‘Notes from the history of leprosy’, International Journal of Leprosy, 41 (1973), 220–​37.

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6 M. Vollset, ‘Globalizing leprosy: A transnational history of production and circulation of medical knowledge, 1850s–​1930s’, Ph.D. dissertation (University of Bergen, 2013), pp. 47–​51. 7 Danielssen and Boeck, Om spedalskhed, p. 98. This fits the timeline presented by F.-O. Touati in Chapter 2 of this volume. 8 ‘Den störste Deel af Europa har i en tidligere Periode været frygtelig hjemsögt af Spedalskheden, men har ved sine kraftige Forholdsregler befriet sig for den. Hos os staae vi, hvad denne Sygdom angaaer, paa det samme Punkt, som ved andre Lande i Middelalderen, vi maa slaae ind paa en lignende Vei som i hine Tider, om vi ikke ville see enkelte Egnes hele Befolkning tilintetgjöres ved denne Sygdom.’ Danielssen and Boeck, Om spedalskhed, pp. 85–​6. 9 Ibid., pp. 94–​100. On the clapper, see L. Demaitre, Chapter 8 in this volume. 10 Danielssen and Boeck, Om Spedalskhed, p. 263. 11 ‘De grusomme Forfölgelser, for hvilke de [Spedalske] vare udsatte’. Ibid., p. 99. 12 Ibid., p. 100. 13 Ibid., p.  101. Also quoted in J.  Y. Simpson, ‘Antiquarian notices of leprosy and leper hospitals in Scotland and England, Part I’, Edinburgh Medical and Surgical Journal, 56(1) (October 1841), 301–​30 (p. 303). Like Danielssen and Boeck, Simpson argued that leprosy was caused by a ‘hereditary taint’. 14 ‘The Honorary Secretaries’ report from the First International Leprosy Conference’, in Mitteilungen und Verhandlungen der internationalen wissenschaftlichen Lepra-​Konferenz zu Berlin im October 1897, Vol. II (Berlin: August Hirschwald, 1897), pp. 191–​2. 15 M. Vollset, ‘Fra lidelse til trussel:  Spedalskheten I  Norge på 1800-​ tallet’, M.A.  thesis (University of Bergen, 2005); M.  Hammerborg, ‘Spedalskhet, galeanstalter og laboratoriemedisin:  Endringsprosesser i medisinen på 1800-​tallet i Bergen’, Ph.D.  dissertation (University of Bergen, 2009); A. Andresen, ‘ “Patients for life”:  Pleiestiftelsen Leprosy Hospital 1850s–​ 1920s’, in A. Andresen, T. Grønlie and S. A. Skålevåg (eds), Hospitals, Patients and Medicine 1800–​ 2000 (Bergen: Rokkansenteret, 2004), pp. 93–​116. 16 An outbreak of measles in 1846, which decimated the populations of the institutions, also contributed to the decision. E. Ehlers, ‘Conditions under which leprosy has declined in Iceland’, in G. Newman, E. Ehlers and S. P. Impey, Prize Essays on Leprosy (London:  New Sydenham Society, 1895), pp. 151–​88, esp. p. 159.

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17 Report on Leprosy of the Royal College of Physicians Prepared for Her Majesty’s Secretary of State for the Colonies (London: Her Majesty’s Stationery Office, 1867), p.  vi. Quoted in S.  S. Pandya, ‘Leprosy in the Bombay presidency, 1840–​1897: Perceptions and approaches to its control’, Ph.D. dissertation (University of Mumbai, 2001), pp. 41–​2; Edmond, Leprosy and Empire, pp. 46, 51–​60. 18 J. Y. Simpson, ‘Antiquarian notices of leprosy, Part I’; J. Y. Simpson, ‘Antiquarian notices of leprosy and leper hospitals in Scotland and England, Part II:  The nosological nature of the disease’, Edinburgh Medical and Surgical Journal, 57(150) (January 1842), 121–​56; J. Y. Simpson, ‘Antiquarian notices of leprosy and leper hospitals in Scotland and England, Part III: The etiological nature of the disease’, Edinburgh Medical and Surgical Journal, 57(151) (April 1842), 394–​429. 19 R. Virchow, ‘Zur Geschichte des Aussatzes, besonders in Deutschland, nebst einer Aufforderung an Aerzte und Geschichtsforscherer’, Archiv für pathologische Anatomie und Physiologie und für klinische Medizin (also known as Virchow’s Archive), 18 (1860), 138–​62. 20 Deutsche Klinik, 25 April 1860, 159–​60; Medical Times and Gazette, 28 July 1860, 93–​4; Lancet, 28 July 1860, 90. 21 R. Virchow, ‘Zur Geschichte des Aussatzes und der Spitäler, besonders in Deutschland: Zweiter Artikel’, Virchow’s Archive (1860), 273–​93; R. Virchow, ‘Zur Geschichte des Aussatzes und der Spitäler, besonders in Deutschland:  Dritter Artikel’, Virchow’s Archive (1860), 43–​93; R. Virchow, ‘Zur Geschichte des Aussatzes und der Spitäler, besonders in Deutschland:  Vierter Artikel’, Virchow’s Archive (1861), 166–​98; R. Virchow, ‘Zur Geschichte des Aussatzes und der Spitäler, besonders in Deutschland: Fünfter Artikel’, Virchow’s Archive (1861), 459–​512. 22 Kalisch, ‘Overview of research’, p. 133. 23 On ideas about the importation of leprosy to the West as a result of the crusades, see Touati, Chapter 2 in this volume. 24 A. Hirsch, Handbuch der historisch-​geographischen Pathologie: Die chronischen Infections-​und Intoxications-​Krankheiten, parasitäre Wundkrankheiten und chronische Ernährungs-​Anomalien vom historisch-​geographischen Standpunkte, 2nd edn, Vol. II (Stuttgart: Ferdinand Enke, 1883), p. 5. 25 Ibid., pp.  1–​40. Hirsch’s handbook was translated into English by Charles Creighton for the New Sydenham Society in London in 1885. 26 ‘Recent official correspondence relating to leprosy’, British and Foreign Medico-​Chirurgical Review (1874), 206–​7. 27 Hirsch, Handbuch, Vol. II, pp. 5–​6. 28 G. A. Hansen, ‘Indberetning til det Norske medicinske Selskab i Christiania om en med understøttelse af selskabet foretagen reise

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for at anstille undersøgelser angaaende spedalskhedens aarsager, tildels udførte sammen med forstander Hartwig’, Norsk magazin for lægevidenskaben, 3(9) (1874), 1–​88; G. A. Hansen, ‘On the etiology of leprosy’, British and Foreign Medico-​Chirurgical Review, 55 (1875), 459–​89; G. A. Hansen, ‘The bacillus of leprosy’, Quarterly Journal of Microscopic Sciences, new series, 20 (1880), 92–​102. Also printed in Nordiskt medicinsk arkiv, 3 (1880), 1–​10; Virchow’s Archive, 79 (1880), 32–​42; Archive de Biologie, 1 (1880), 1–​16. 29 W. Munro, Leprosy (Manchester:  John Heywood, 1879). See also Touati, Chapter 2 in this volume. 30 Jo Robertson has examined how seeing leprosy as a foreign threat (a ‘yellow peril’) in colonial Queensland, Australia, linked the disease to racism. J. Robertson, ‘In a state of corruption: Loathsome disease and the body politic’, Ph.D.  dissertation (University of Queensland, Brisbane, 1999). 31 Hansen, ‘Indberetning’. 32 A. Kermorgant, ‘Des dangers que nous fait courir la lèpre’, Lepra bibliotheca internationalis, 3(1) (1902), 43–​4. 33 G. Newman, ‘On the history of the decline and final extinction of leprosy as an endemic disease in the British Islands’, in Newman, Ehlers and Impey, Prize Essays on Leprosy, pp. 1–​150 (p. 91). On leprosy and diet, see E. Brenner, Chapter 6 in this volume. 34 Newman, ‘On the history of the decline’, p. 14. 35 Ibid., p. 109, italics in the original. 36 Ehlers, ‘Conditions’, p. 187. 37 For an analysis of the journal, see Vollset, ‘Globalizing’, pp. 232–​7. 38 See, for instance, J. Hutchinson, ‘Memoranda for future investigations as to the cause of leprosy’, Journal of the Leprosy Investigation Committee, 1 (1890), 68; J. Hutchinson, ‘Discussion on leprosy:  Its etiology, histology and treatment’. Lepra bibliotheca internationalis, 4(3) (1905), 188–​ 203; J. Hutchinson, On Leprosy and Fish-​ Eating:  A Statement of Facts and Explanations (London: Archibald Constable, 1906). 39 Z. Pacha, La contagion de la lèpre en l’état de la science (Paris: Masson et Cie, 1907). 40 See, for instance, L. Rogers and E. Muir, Leprosy (Bristol:  John Wright, 1925). 41 See, for example, S. N. Brody, The Disease of the Soul:  Leprosy in Medieval Literature (Ithaca, NY: Cornell University Press, 1974). 42 A. Bewell, Romanticism and Colonial Disease (Baltimore:  Johns Hopkins University Press, 1999), pp. 251–​2. Although Bewell does

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not use leprosy as a specific example, he offers a framework for the understanding of British fears of tropical diseases, abroad and at home. 43 G. Daws, Holy Man: Father Damien of Molokai (New York: Harper and Row, 1973), p. 10. 44 London Times, 13 May 1889. 45 A. Lambert, ‘Leprosy: Present and past’, The Nineteenth Century, 16 (1884), 210–​27 (p. 212). 46 H. P. Wright, Leprosy, an Imperial Danger (London: J. & A. Churchill, 1889), p. 93. 47 M. Mackenzie, ‘The dreadful revival of leprosy’, The Nineteenth Century (1889), 925–​41 (p. 926). 48 For examples of other tropical diseases whose potential to travel to Europe alarmed colonisers, see M. Worboys, ‘Tropical diseases’, in W. F. Bynum and R. Porter (eds), Companion Encyclopedia of the History of Medicine (London: Routledge, 1993), p. 531; and Bewell, Romanticism and Colonial Disease. 49 G. Cantor and S. Shuttleworth (eds), Science Serialized: Representation of the Sciences in Nineteenth-​Century Periodicals (Cambridge:  MIT Press, 2004); G. Cantor, G.  Dawson, G.  Gooday, R.  Noakes, S. Shuttleworth and J. R. Topham, Science in the Nineteenth-​Century Periodical (Cambridge: Cambridge University Press, 2004); M. Coyer, Literature and Medicine in the Nineteenth-​Century Periodical Press (Edinburgh: Edinburgh University Press, 2017). 50 ‘The spread of leprosy’, British Medical Journal (5 November 1887), 1022–​3. 51 Wright, Leprosy, an Imperial Danger, p. 4; H. P. Wright, Leprosy and Segregation (London: Parker, 1885), p. 90. 52 Mackenzie, ‘The dreadful revival of leprosy’, p. 933. 53 Lambert, ‘Leprosy’, p. 211. 54 Wright, Leprosy and Segregation, p. 92. 55 A. Lambert, ‘Leprosy: Past and Present’, The Nineteenth Century, 16 (1884), 467–​89 (p. 488). 56 Newman, ‘On the history of the decline’, p. 92. 57 R. Roose, Leprosy and Its Prevention:  Illustrated by Norwegian Experience (London: H. K. Lewis, 1890), pp. 87–​8. 58 Rogers and Muir, Leprosy, pp. 5–​6. 59 Hutchinson, On Leprosy and Fish-​Eating, p. 8. 60 Kew, The National Archives (TNA), CO 685/​ 6, Uganda Medical Department Annual Report, 1923, p. 7. 61 Rogers and Muir, Leprosy, pp. 98–​100. 62 M. Vaughan, Curing Their Ills:  Colonial Power and African Illness (Stanford:  Stanford University Press, 1991), p.  79; K. Vongsathorn,

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‘  “First and foremost the evangelist”? Mission and government priorities for the treatment of leprosy in Uganda, 1927–​48’, Journal of Eastern African Studies, 6(3) (2012), 544–​60. 63 T. O. Beidelman, Colonial Evangelism:  A Socio-​ Historical Study of an East African Mission at the Grassroots (Bloomington:  Indiana University Press, 1982), p. 21; A. Conklin, A Mission to Civilize: The Republican Idea of Empire in France and West Africa, 1895–​ 1930 (Stanford:  Stanford University Press, 2008); C. Hall, Civilising Subjects: Metropole and Colony in the English Imagination, 1830–​1867 (Chicago: University of Chicago Press, 2002); B. Stanley, Bible and the Flag: Protestant Mission and British Imperialism in the Nineteenth and Twentieth Centuries (Leicester: Apollos, 1990), pp. 157–​61. 64 For further discussion of the political, social and religious goals that motivated in-​patient leprosy treatment, see:  K. Vongsathorn, ‘Public health or public good? Humanitarian agendas and the treatment of leprosy in Uganda’, in B. Everill and J. Kaplan (eds), The History and Practice of Humanitarian Intervention and Aid in Africa (Houndmills: Palgrave Macmillan, 2013), pp. 43–​66. 65 A. Jessop, ‘The coming of the friars’, pp. 80, 90, cited in Newman, ‘On the history of the decline’, p. 75. 66 Newman, ‘On the history of the decline’, pp. 105–​6. 67 Rogers and Muir, Leprosy, p. 51. 68 B. Callahan, ‘  “Veni, VD, Vici”? Reassessing the Ila syphilis epidemic’, Journal of Southern African Studies, 23(3) (1997), 421–​ 40; M. Vaughan, ‘Syphilis in colonial East and Central Africa:  The social construction of an epidemic’, in T. Ranger and P. Slack (eds), Epidemics and Ideas: Essays on the Historical Perception of Pestilence (Cambridge: Cambridge University Press, 1992), pp. 269–​302. 69 L. de la Marche, La lèpre et les léproseries (Paris, 1892), in L. W. Mulhane, Leprosy and the Charity of the Church (Chicago:  D. H. McBride, 1896), p. 75. 70 Ehlers, ‘Conditions’, p. 168. For an analysis of the seed/​soil metaphor before and after the identification of the leprosy bacillus, see J. Robertson. ‘Leprosy and the elusive M. leprae: Colonial and imperial medical exchanges in the nineteenth century’, História, ciências, saúde Manguinhos, 10, supplement 1 (2003), 13–​40. 71 M. Worboys, ‘The colonial world as mission and mandate:  Leprosy and empire, 1900–​1940’, Osiris, 15 (2000), 207–​18 (p. 213). 72 Roose, Leprosy and Its Prevention, p. 11. 73 Colchester, UK, LEPRA Archives, BELRA Annual Report, 1928, p. 13; LEPRA Archives, BELRA Annual Report, 1934, p. 3. 74 Lambert, ‘Leprosy’, 217.

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75 Ibid. 76 TNA, MH 55/​324, letter from Pirrie to Shaw, 1934. 77 TNA, MH 55/​324, minute sheet, Cardiff County Borough, 1933. 78 For a discussion of how fear and paranoia about leprosy developed in nineteenth-​and twentieth-​ century Britain, see: K. Vongsathorn, ‘Gnawing pains, festering ulcers, and nightmare suffering: Selling leprosy as a humanitarian cause in the British Empire, c. 1890–​1960’, Journal of Imperial and Commonwealth History, 40(5) (2012), 863–​78. 79 ‘King’s Bench Division:  A leper in a lodging house. Humphreys v. Miller and others’, London Times, 16 May 1916. 80 L. Rogers, ‘Leprosy scourge:  Erroneous ideas about contagiousness’, Statesman, 11 October 1923. 81 ‘High Court of Justice, King’s Bench Division:  A leper in a lodging house. Humphreys v. Miller and others’, London Times, 19 May 1916. 82 J. Lowe, ‘Comments on the history of leprosy’, Leprosy Review, 18(2–​3) (1947), 61, interpreting C. Creighton, A History of Epidemics in Britain (Cambridge: Cambridge University Press, 1891). 83 W. MacArthur, ‘Medieval “leprosy” in the British Isles’, Leprosy Review, 24 (1953), 8–​19 (p. 11); T. Shapter, A Few Observations on the Leprosy of the Middle Ages (Exeter: Roberts, 1835), pp. 8–​9. 84 Newman, ‘On the history of the decline’, p. 54; Lowe, ‘Comments on the history of leprosy’, 63. 85 Lambert, ‘Leprosy’, 467. 86 Ibid., 488. 87 Mackenzie, ‘The dreadful revival of leprosy’, 940. 88 Matthew 10:8. 89 Wright, Leprosy and Segregation, p. 92. 90 Mulhane, Leprosy and the Charity of the Church, p. 73. 91 Wright, Leprosy and Segregation, p. 92. 92 Mulhane, Leprosy and the Charity of the Church, p. 74. On the Order of Saint Lazarus, see R. Hyacinthe, Chapter 10 in this volume. 93 K. Vongsathorn, ‘ “Things that matter”:  Missionaries, government, and patients in the shaping of Uganda’s leprosy settlements, 1927–​ 1951’, D.Phil. dissertation (University of Oxford, 2012), pp. 115–​60. 94 Uganda, Jinja District Archives, Medical Leprosy, letter from District Medical Officer Busoga to District Commissioner Busoga, 19 April 1944. 95 Vongsathorn, ‘Public health or public good?’, pp. 43–​66. 96 R. M. Langley, ‘Report of happenings among the lepers’, Ruanda Notes, 54 (October 1935), 15. 97 R. M. Langley, ‘News of the lepers’, Ruanda Notes, 41 (July 1932),  16–​17.

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98 R. M. Langley, ‘Miss Langley’s account of answered prayer’, Ruanda Notes, 43 (1933), 11–​12. 99 Z. Gussow and G. Tracy, ‘Stigma and the leprosy phenomenon’, Bulletin of the History of Medicine, 44(5) (1970), 425–​ 49; K. Vongsathorn, ‘Discovering the “leper”:  Shifting attitudes towards leprosy in twentieth-​century Uganda’, in J. Reinarz and K. Siena (eds), A Medical History of Skin: Scratching the Surface (London: Pickering & Chatto, 2013), pp. 99–​111. 100 Vongsathorn, ‘Gnawing pains’. 101 Thomas of Celano, ‘Vita secunda’, in R. J. Armstrong, J. A.  W. Hellmann and W. J. Short (eds and trans.), Francis of Assisi:  Early Documents, 3 vols (New  York:  New City Press, 1999–​2001), Vol. II:  The Founder (2000), p.  249. On Saint Francis and leprosy, see C. A. Krolikoski, Chapter 9 in this volume. 102 C. Peyroux, ‘The leper’s kiss’, in S. Farmer and B. H. Rosenwein (eds), Monks and Nuns, Saints and Outcasts (Ithaca, NY: Cornell University Press, 2000), pp. 172–​88 (p. 180). 103 ‘Round the mission’, Day Star in Africa, 12 (January 1949), 10. 104 R. Cochrane, Biblical Leprosy:  A Suggested Interpretation (London: Tyndale, 1961), p. 15. 105 ‘The lepers of Molokai’, British Medical Journal (23 October 1886), 778. 106 ‘A victim of leprosy’, British Medical Journal (26 January 1889), 222. 107 R. Pringle, ‘The government of India and leprosy in India’, London Times, 12 June 1889; London Times, 13 May 1889. 108 ‘The lepers of Molokai’. 109 H. B. Chapman, ‘The late Father Damien’, London Times (14 May 1889); ‘Leprosy’, British Medical Journal (15 June 1889), 1364–​5. 110 W. Tebb, Leprosy and Vaccination (London:  E. W.  Allen, 1893), p. 290. 111 Daws, Holy Man, p. 12. 112 London, Wellcome Collection, PP/​ROG/​C.13/​53; L.  Rogers, ‘Notes on the contagiousness of leprosy and of workers in leper hospitals’, 22 March 1935. 113 R. Stegall, The Month (1889), quoted in Pall Mall Gazette, 15 June 1889, 3. 114 C. Rawcliffe, ‘Learning to love the leper: Aspects of institutional charity in Anglo-​ Norman England’, Anglo-​Norman Studies, 23 (2001), 231–​50 (p. 242); Alice the Leper: Life of St Alice of Schaerbeek, trans. Martinus Cawley, O.C.S.O. (Lafayette, OR: Guadalupe Translations, 2000), p. 21.

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115 B. Moiser, ‘British Empire leprosarium’, Leprosy Review, 9(3) (1939), 169–​72. 116 TNA, MH 55/​554, memo from Sir Arthur Downes, 1914. 117 Daily Chronicle, 2 June 1914; Essex County Chronicle, 26 June 1914. 118 Essex Weekly News, 10 July 1914. 119 Personal interview with Mother Gloria from the Community of the Sacred Passion, quoted in J.  Bhoyroo, ‘The British leper’, B.Sc. thesis (Wellcome Institute for the History of Medicine, London, 1997), p. 42. 120 Essex Weekly News, 26 June 1914. 121 Essex County Chronicle, 10 July 1914. 122 Ibid. 123 Essex Weekly News, 5 June 1914. 124 J. Buckingham, Leprosy in Colonial South India:  Medicine and 60; K. Inglis, Confinement (New  York:  Palgrave, 2002), pp. 36–​ Mai lepera:  Disease and Displacement in Nineteenth-​ Century Hawaii (Honolulu:  University of Hawaii Press, 2012); L. K. Seng, ‘ “Our lives are bad but our luck is good”:  A social history of leprosy in Singapore’, Social History of Medicine, 21(2) (2008), 291–​309 (pp. 302–​5); E. Silla, People are Not the Same:  Leprosy and Identity in Twentieth-​Century Mali (Portsmouth:  Heinemann, 1998), p. 27; S. Shankar, ‘The social dimensions of Christian leprosy work among Muslims:  American missionaries and young patients in colonial northern Nigeria, 1920–​ 40’, in D. Hardiman (ed.), Healing Bodies, Saving Souls:  Medical Missions in Asia and Africa (Amsterdam:  Rodopi, 2006), pp.  281–​305 (p. 282); Vongsathorn, ‘ “Things that Matter” ’, pp. 217–​82.

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Index

Abingdon, abbey of 74 Abraham, biblical figure 228 Academy of Sciences, Paris, Prix Monthyen of 349 account books 185 Acre 296, 307 Adela of Louvain, queen of Henry II 103 Aderald, saint 56 advice literature, medical 163 advocacy 255 Africa 21, 35 age 24 Agile, saint, abbot of Rebais 55 Aire 171 Alexander III, pope 99 Cor Nostrum of 301 Alexander IV, pope 296 almsgiving 170–1, 247 almshouses 109, 110, 135, 150, 152 al-​Walid, caliph  60 Amatus, saint 272 Ambrosius of Milan 68 Ami and Amile 69 amputation 143 Amsterdam 250 ancestry 24, 33 ancient DNA (aDNA) analysis see archaeology,

bioarchaeology, ancient DNA (aDNA) analysis Andersen, Johs 26, 47 Andrews Diptych, the 48 Angier, Michel, bookseller of the University of Caen 165 Anonymous of Placentia, the 60 Antioch 54 Aragon, crown of 325 archaeology 131 bioarchaeology 24–5, 33, 220 ancient DNA (aDNA) analysis 4, 5, 25, 32, 34, 131 and identity 22–3 urban sites for 35, 38 Aretaeus of Cappadocia, physician 47, 60 Argentan 72 Arnaldi, Hugo, benefactor of the leprosy hospital of Saint Matthew of the Bourg, Narbonne 329 Arnaldus, Guillelmus, merchant 329 Arnaldus, leprosus of the leprosy hospital of Saint Laurence of the Cité, Narbonne 329 Arndorfer Altar, the 244 Asia 35

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384

Index

Asia Minor 48 Assisi 274 Athanasius, saint, Life of 56 Atkynson, William, master of Saint Mary Magdalen, Winchester 150 Attard, Joseph, of Malta, leprosy patient 365 atte Herst, Thomas, of Canterbury 108 Augustinians, monastic order of 133 Augustinian rule 296 Australia 354 Auvergne 247 Avicenna (Ibn-​Sina), Canon of 110 bacon 174 bacteriology 348 Baker, Philip, master of Saint Mary Magdalen, Winchester 154 Bald’s Leechbook 133 Baldric of Bourgueil 58 Baldwin IV, king of Jerusalem 37, 301 Barbara, saint 215, 253 Barber, Malcolm, historian 305 Barnhouse, Lucy 6, 7, 9, 230 Basil, saint 53 Batalla, leprosus of the leprosy hospital of Saint Matthew of the Bourg, Narbonne 329 Bath, priory of 100 bathing 166 Bedford castle 174 beef 164, 167 beer 166 begging 333 begging bowls 235 Belgium 251

bells 218, 333, 335 BELRA see British Empire Leprosy Relief Association (BELRA) Benedictine rule 82, 133 Benedict of Peterborough 12, 70 Berlinghieri, Bonaventura, of Lucca, artist, altarpiece by 235 Bernard, saint, De præcepto et dispensatione of 83 Bernarda, wife of Hugo Arnaldi, benefactor of the leprosy hospital of Saint Matthew of the Bourg, Narbonne 329 Béroul, Tristan of 69 Birmingham 358 bishops 310 Black Death, the 108, 191, 323 see also plague Blackfriars, School Street, Ipswich, monastery 37 Blankenau 194 Blomefield, Francis, Norfolk antiquary 106 bloodletting 165, 166 Boeck, Carl Wilhelm, Om Spedalskhed (On Leprosy) of (with Daniel Danielssen) 349 Boeckl, Christine, art historian 210 Bonaventure, Minister General of the Order of Saint Francis, Legenda major of 280–2 books of the dead (mortilegia) 104–5, 106–7 Bordeaux 246 Boudon, Robert, licensed to beg on behalf of leprosi 247

583

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Index Bourg-​Achard, Augustinian priory of 170 Brabant 249, 251 Brazil 21 International Leprosy Congress (1947) 7 bread 163, 165, 166, 168, 171, 172 bread and water, punitive diet of 172, 336 Brenner, Elma 7, 8, 10, 184 Breviarium practice, the 31 Bridget of Sweden, saint, Liber celestis of 112 Bridport, provosts of 114 Britain 39, 48, 355, 356, 358, 361 British Colonial Office, Report on Leprosy (1867) 351 British Empire Leprosy Relief Association (BELRA) 362, 364 British Library, the 211 British Medical Journal, the 371 British National Leprosy Fund, the 355 Brooke, Rosalind 277 Bruegel, Pieter, artist ‘Battle Between Lent and Carnival’ of 250 ‘Census at Bethlehem’ of 249 Bruges 232, 248, 253 bugloss (plant) 165 Byzantine Empire 45 Calcutta 95 Cambridge, mayor and bailiffs of 113 cancer 5 Canterbury 113, 132 Carcassonne, seneschal of 335 Carcassonne-​Béziers, seneschalsy of 324

385

Cardiff, Infectious Diseases Hospital in 365 cartularies 185, 188, 190 Casteljaloux 246 Castiglione del Lago 237 Castres 246 Celsus 47 cemeteries 24, 26, 38 Cergy-​lès-​Pontoise, wine from  169 chantries 109, 114, 148 charity 3, 6, 11, 12, 50, 57, 68, 85, 97, 162, 237, 242, 247, 255, 269, 284, 285, 328, 347, 349, 358, 367–72, 373, 374 in Islam 60 Charles II, king of England 153 Charles V, Holy Roman Emperor 251 charters 165, 185, 189, 309 Chelmsford Rural Council 372 chicken 167 children 35, 37 China 355 leprosy, medieval 2–3 Christ 370 Christus leprosus 67, 81, 83, 97, 280, 285, 286 encounters with leprosi 229 as Man of Sorrows 244 Christianity 368 civilisation 348, 358, 359, 360, 361, 363, 365, 374 clappers 9, 12, 310, 333, 350 as emblem of poor leprosus 240 extant artefacts 253, 254 iconography of 220–3 regional variations in 223, 229 as means of social control 246 official control of use of 249 role of 233, 245, 256

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386

Index

clothing 215, 235, 242, 274, 276, 303, 350, 364 cloaks 237, 310 gloves 215, 238 hats 224, 227, 228, 232, 237, 238, 242 hoods 310 Cologne 193 colonial leprosy settlements 348 commemoration 101, 104, 114 compassion 328 confraternities 11, 105–6, 250, 251 Constantine I, Roman emperor 53 Constantine VII Porphyrogenitus, Byzantine emperor 54 Constantinople 53, 55 medical influences from 56 contagion 162, 247, 276, 304, 315, 327, 350, 353, 358, 366, 369, 373 contamination 162, 173, 328 conversion (religious) 81 Cooper, Richard Tennant, artist 218 Coventry 100, 113 Crescentius of Jesi, Minister General of the Order of Saint Francis 277, 279 crossroads 183 crusaders 305 crusades, the 352 Cyprus 365 Daily Chronicle, newspaper 372 Damascus 60 Damien, Father, Belgian missionary 348, 358, 370–2 Danielssen, Daniel, physician, Om Spedalskhed (On Leprosy) of (with Carl Wilhelm Boeck) 349 de Bage, Martinus, brother of the leprosy hospital of Saint

Matthew of the Bourg, Narbonne 329 de Blois, Henry, bishop of Winchester 138 de Collemezzo, Peter, archbishop of Rouen 173 de Flori, Renaud, master of the Order of Saint Lazarus 296 de Fons, Petrus 324 de Gordon, Bernard, physician, Lilium medicine of 209 Castilian version 209 Deir Dosi, monastery 52 de Joinville, Jean, chronicle of 299, 300, 304 de Leigh, Sir William, of Bridport 114 Demaitre, Luke 2, 7, 314, 331 de Mancum, Ildobrandinus, benefactor of the leprosy hospital of San Lazaro, Siena 327 de Mondeville, Henri, surgeon 164, 165 de Montseret, Arnaldus, leprosus of the leprosy hospital of Saint Matthew of the Bourg, Narbonne 329 de Perpignan, Bernardus, weaver, administrator of the leprosy hospital of Saint Matthew of the Bourg, Narbonne 327, 336 de Quillan, Guillelmus, leprosus of the leprosy hospital of Saint Matthew of the Bourg, Narbonne 329 des Innocens, Guillaume, surgeon of Toulouse 246 des Moulins, Guyart, Bible historiale of 224

783

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Index de Valentia, Maria, duchess of Pembroke 147 de Vendôme, Matthieu, abbot of Saint-​Denis  208 Devenish, Thomas 147 di Adam, Salimbene, Chronicle of 298–9 diet 10, 33, 336, 355, 356, 361, 363 and health 161, 163 as marker of identity 167 regulation of 165 religious abstinence 166 di Neri, Giovanni 330 disability 10, 14, 255, 304 Dives and Lazarus, parable of 96, 214, 221, 223, 224–9, 253, 294, 325 donkey meat 164 Dortmund 227 Dover 307 drinking vessels 214, 227, 248, 249 Dross, Fritz 171 Duquesnoy, Jehan, called ‘le Bourguignon’, leprosus 169 dysentery 51 Eadmer, chronicler 132, 134, 137 East Africa 370 eating utensils 162 Edward I, king of England 104 Edward VI, king of England 153 eggs 163, 165, 166, 167, 168 Egle, Tassart, butcher and burgess of Saint-​Omer, leprosus 174 Egypt 46, 47, 52, 299 Ehlers, Edvard, physician 355 Elisabeth of Hungary, saint 214, 218

387

care of leprosy sufferer 285 empire 347, 357, 359, 362, 374 British Empire, the 351 colonial governments 362, 369 justification of 364 legacy of 374 employment 24 environmental health 110 see also public health epilepsy 54 Epistle to the Hebrews, the 58 Ermengau, Matfré, of Béziers, Breviari d’Amor of 233 Essex County Council 373 Europe 35 exempla 285 exercise 166 Fabri, Guillelmus 324 Fabri, Sicard 324 fairs 136 famine 355 festivities 250–1 Finland 352 First Crusade, the 58, 294 First International Leprosy Conference, Berlin (1897) 351 fish 164, 165, 166 FitzAlice, Robert, of London 112 FitzAlwyn, Henry, mayor of London 112 Florence, Council of (1438) 97 flour 172 FMSA see Franciscan Missionary Sisters for Africa, the (FMSA) food 164, 303 contaminated 173 and leprosy 174 shortages of 167

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388

Index

France 361 Francis of Assisi, saint 11, 54, 237, 370 conversion of 274, 275, 276, 277, 281, 284 interactions with leprous poor 272, 275, 276, 282–3 life of 235 legacy of 272 order of 270, 273–4, 275, 276, 285 Testament, The, of 269, 284 Franciscan Missionary Sisters for Africa, the (FMSA) 370 Frankfurt 230 leprosy examinations in 185, 191–5 physicians of 191, 193 French disease, the 4, 38 Frideswide, saint 272 Fromond, John, steward of Winchester College 151 Fursey, saint 56, 272 Galen 47 Geltner, Guy 187 gender 8, 10, 23, 36, 166, 229–30, 303, 371 Geoffrey, abbot of St Albans 103 Gerard of Nazareth 57 Geraldus, leprosus of the leprosy hospital of Saint Laurence of the Cité, Narbonne 329 Gerbert, abbot of Saint-​Wandrille  81 germ theory 374 Germany 48, 251, 312, 352 Gilbert Crispin, De simoniacis of 68

Girard, René, scapegoat theory of 67 global history 45 Glover, Emma, of Wymondham 105 Glover, John, master of the leprosy hospital at Gaywood 105 Glover, Robert, of Wymondham 105 Godwine, servant at Boxgrove priory 80 Gospels, the 273, 274 Gouda, Lazaruspoortje in 251 grain 169 Gratian, Decretum of 83 Great Chesterford 5 Greece 352 Green, John, of Cambridge 114 Gregory of Nazianzus 70 Gregory of Nyssa, saint 70 Gregory of Tours, saint 55, 56 Books of Miracles of 48 Grenier, Eustache III, lord of Caesarea 302 Grenier, Hugh I, lord of Caesarea 302 Grimsby 113 Grmek, Mirko 46 Gruuthuse family, of Bruges 253 Gui, Bernard, Dominican friar and Inquisitor 241 Guibert of Nogent 58 guilds 250 of carpenters 251 Guy de Chauliac 31 Haarlem, coat of arms of 254 hagiography 48, 51, 53, 55, 133, 185, 247, 270, 272, 274, 277, 285, 370 Haimon de Savigny 71

983

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Index Haisia, sister of La Madeleine hospital, Rouen 167 Hansen, Gerhard Armauer, physician 353, 354 Hardi, Jean, of Rouen 171 Hawaii 348, 353, 354, 371 Haymon d’Auxerre 56 healing sanctuaries 56 Hedwig of Silesia, saint 286 Henry II, king of England 166, 167 Henry III, king of England 174 herring 166, 167, 168 Hilary, bishop of Chichester 100 Hildegard, saint, prayer book of 211 Hippocratic corpus 46 Hirsch, August, professor of medicine at the University of Berlin 353 Holbein the Elder, Hans, artist 214 Holy Land, the 45, 52, 295, 305 Holy Week 12, 171, 333 homiletic writings 133 horns (musical instruments) 215 Hospitalis, Bernardus, administrator of the leprosy hospital of Saint Matthew of the Bourg, Narbonne 336 hospitality 162, 166, 175 hospitals (not leprosy hospitals) medieval 306 Casa della Misericordia, Siena 335 Hôtel-​Dieu, Paris  175 La Madeleine, Rouen 133, 167 monastic organisation of 133 Saint Cross, Winchester 145 Saint Gregory, Canterbury 132 Saint John, Canterbury 132

389

Santa Maria della Scala, Siena 325, 335 Notre-​Dame, Tournai  242 Hugh of Amiens, archbishop of Rouen 82, 84 Hugh of Lincoln, saint, Life of 68, 134 Hugh of Saint-​Victor 82, 83 humanitarianism 362, 374 humours, the 163 Humphreys, Mr, lodging-​house keeper in Britain 365 Hussey, Walter 100 Hutchinson, Jonathan, physician 356 Hyacinthe, Rafaël 2, 10 hygiene 363, 364, 371 Hywel Dda, laws of 103 Iberian Peninsula, the 352 Ibn Butlan, physician 54 Iceland 351, 355, 373 identity badges denoting 242 collective 9–10, 162, 327, 328 fluidity of 23 individual 8–9, 22, 24, 34, 162, 196 and reputation 71 immorality 363 impetigo 52 India 21, 23, 355 indulgences 102, 106, 107, 115, 305, 308 influenza 51 Innocent III, pope 103 Innocent IV, pope 306 intercession 11, 84, 95, 100, 101, 107, 115–16, 149, 270, 305, 328, 337 Ireland 48 Irvine, William C., Reverend 95

390

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Isidore of Seville, Etymologies of 52 Italy 273 iudicium leprosorum see leprosy, medieval, diagnostic examinations Jacques of Vitry 83, 96, 98, 306 Jaffa 299 James the Simple, Franciscan brother 282 Jaume II, king of Aragon 241 Jeanne, Damien 3, 8 Jerome, saint 81 Jerusalem 295, 305 Tancred tower 294 Jews 242 John II Comnenus, Byzantine emperor 54 John XXII, pope 147 John de Stratford, bishop of Winchester, Register of 147 John of Pontoise, bishop of Winchester, Register of 147 John of Salisbury, Policraticus of 69 John ‘the King’, monk of Taunton 72 Jordan, river 52 Judaean Desert 52 Justinian, Eastern Roman emperor 54 Kalisch, Philip 352 Kellawe, Richard, bishop of Durham 100 Kempe, Margery, mystic 112 Kermogant, Alexandre, Inspector General of the French

Index colonial health services 354 Kevin, Mother, founder of the Franciscan Missionary Sisters for Africa 370 Kilwardby, Robert, archbishop of Canterbury 110 King’s Lynn 104 Kinzelbach, Annemarie 191 kissing 275–6, 278 see also people with leprosy, kissing of Krolikoski, Courtney A. 11 Lacnunga, the 133 Lacock Abbey 167 Lactantius 68 La Forbie, battle of 298, 300 lamb 164, 172 Lambert, Agnes, writer 358, 365, 367, 370 Lanfranc, archbishop of Canterbury 59, 81, 132, 133 Langley, Thomas, bishop of Durham 109 language 6, 68, 74–80, 300, 307, 323, 329 La Queste del Saint Graal 69 Last Supper, the 162, 171 Lateran, Third Council of (1179) 9, 334 Laurence, saint 325 Lazarus, saint 222, 224, 251, 253, 294, 311, 312 Le Bec, abbey 133 Le Bras, Gabriel 105 Le Forestier, Thomas, physician 113 Legend of Perugia, the 283 Legend of the Three Companions, the 277, 278 Le Goff, Jacques, historian 274, 275

193

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Index Le Grand, Léon 185 lentils 164 le Palmer, James, Omne bonum of 211 ‘leper scare’ (1889) 348, 357, 359, 371 Lepra Bibliotheca Internationalis (journal) 356 leprosaria see leprosy hospitals, medieval leprosy ancient as chronic illness 48 and desire 68 as skin disorder 48 terminology 46 in ancient writings 48 early modern diagnostic examinations 248, 255 Hansen’s disease 21 bone changes 30, 33–4 and heredity 350, 351, 357 lepromatous form 21, 26, 34, 47, 51 physical effects 107, 163, 218 sensory effects 28, 30, 31, 163 slow development of 304 stigma 6–7, 22, 39 strains of 32 tuberculoid form 21, 51 medieval and contagion 110, 173, 220, 302 and crusading 305 causation 2–3, 31 chronology of 51 community responses 34, 37 conflation with other skin disorders 10 decline 4–5, 36, 132

391

definitions 2–3 diagnosis of 37, 108, 185, 304, 348, 353 diagnostic examinations 4, 112, 185, 188, 191–5, 220, 237, 254, 329, 331 as divine punishment 270 extra-​institutional contexts 3, 9, 55, 170, 232, 327, 337 faking of 38 global picture 3 iconography of 210, 232–3 incidence of 348, 366–7, 373 materiality of 155, 214 as metaphor for sin 84 negative associations 69 nineteenth-​century perspectives on 21, 36, 39, 347, 373 as religious vocation 10, 11, 85, 96, 102–4, 269, 285, 305, 310, 367 repulsion towards 80 and sin 71 stigma 3, 24 terminology 6–7, 184, 190, 208 in nineteenth and twentieth centuries 349 as religious conversion 369 leprosy hospitals early modern Diest 253 Herbet 247 Malaten, Cologne 253 near Elberfeld 248 integration of 175 medieval 3, 4, 11, 45, 52–4, 84, 278, 347, 351, 367 Aachen 190 administration of 330

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392

Index

leprosy hospitals, medieval (continued) agricultural produce of 167 alms boxes in 101–2 Amiens 173 Beverley 111 Boughton under Blean 108 Brompton on the Bridge 134 buildings of 146 cemeteries of 135, 146 chapel ornaments of 150 chapels of 99–101, 135, 139 Chalon-​sur-​Saône  55 Charolais 351 Colchester 134 Cologne 190 confraternities of 104, 106 Corpo Santo, Siena 325 decline of 97, 102, 108–9, 131 as deserving recipients of charity 328 donations to 326 entrance fees to 109, 162 extra-​mural locations of 137 Glastonbury 135 Gournay-​en-​Bray  167 guests in 166 Hackney 112 Heilig Geist Spital, Mainz (also a multipurpose hospital) 187 High Wycombe 135 hill-​top locations of 132, 137 Holy Innocents, Lincoln 101, 110 infirmaries in 145 integration of 137, 149 La Madeleine, Saint-​Omer  174 lay staff in 108, 162

Lazar House, Norwich 135 maladministration of 111, 335, 336, 337 Meaux 172 Metz 55 as monastic institutions 161 Mont-​aux-​Malades, Rouen 9, 137, 167, 173 municipal protection of 334, 335 Münster 190 non-​leprous residents in 162, 166 see also leprosy hospitals, medieval, lay staff in Old Sarum 134 origins of 132, 134, 329 private accommodation at 169 proximity to roads 137 punishments at 172 religious worship in 98–101 Rumst 251 Saint Bartholomew, Dover 107 Saint Bartholomew, Oxford 135 Saint-​Claude  55 Saint Georg, Mainz 188 Saint George’s, Naestved 26, 37 Saint Giles, Holborn 98, 101, 103, 111 Saint Giles, Maldon 99, 174 Saint Giles, Shrewsbury 98 Saint Jacob, Haarlem 254 Saint James, Chichester 99 Saint James, Doncaster 103, 107 Saint James, Dunwich 101 Saint James, Seaford 100

393

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Index Saint James, Westminster 102 Saint John, Bath 100 Saint John, Thetford 106 Saint Julian, St Albans 103 Saint Laurence, Bristol 110 Saint Laurence of the Cité, Narbonne 324 Saint Laurence, Canterbury 98 Saint Lazarus, Jerusalem 55, 57, 294, 302 Saint Lazarus, Sherburn 99, 109 Saint Leonard, Clattercote 98 Saint Leonard, Northampton 101 Saint Leonard, Nottingham 115 Saint Leonard, West Somerton 98 Saint Leonhard, Nuremberg 172 Saint Margaret and the Holy Sepulchre, Gloucester 103, 104 Saint Margaret, Taunton 105, 135 Saint Mary Magdalen, Bruges 248, 253 Saint Mary Magdalen, Colchester 135 Saint Mary Magdalen, Dudston 98 Saint Mary Magdalen, Exeter 101, 109 Saint Mary Magdalen, Gaywood 104–5, 113 Saint Mary Magdalen, Liskeard 106

393 Saint Mary Magdalen, Ripon 109 Saint Mary Magdalen, Spon 100 Saint Mary Magdalen, Sprowston 99, 106 Saint Mary Magdalen, Stourbridge 135 Saint Mary Magdalen, Winchester 11 see also Saint Mary Magdalen, Winchester, leprosy hospital Saint Mary the Virgin, Ilford 111 Saint Matthew of the Bourg, Narbonne 324, 325, 336 Saint Nicholas Farm, Saint Andrew’s 134 Saint Nicholas, Harbledown 59, 107, 110, 132, 134, 135, 137 Saint Nicholas, York 101, 102, 103, 109 Saint Peter, Bury Saint Edmunds 98 Saint Sepulchre, Hedon 103 Saint Stephen, Jerusalem 52 Saint Thomas, Aizier 163 Saint Zôtikos, Constantinople 53 Saint-​Gilles, Pont-​ Audemer 82, 84 Saint-​Jacques, Bois Halbout 82 Saint-​Lazare, Aumône 169, 186 Saint-​Lazare, Meaux  171 Saints Anthony and Eligius, Cambridge 113 Saints Giles and Anthony, Wilton 103

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394

Index

leprosy hospitals, medieval (continued) Saints James and Mary Magdalen, Chichester 102, 135, 142 Saints Mary and Matthew, Maiden Bradley 96, 103, 107 Saints Mary Magdalen and Anthony, Bridport 114, 115 Salle-​aux-​Puelles, Rouen 166, 170 San Lazaro, Siena 325, 331, 333, 334 segregation of the sexes in 99, 172 servants at 168, 171 silence at 172 South Acre 135 Southwark 112 spiritual services offered by 106 statutes of 165, 169, 171, 172, 173, 185, 186 Valais 55 Walsingham 105 Worms 186–7 modern Delhi 164 Saint Giles Home for Lepers, Essex 365, 373 leprosy settlements 362, 374 Molokai, Hawaii 358 Southern Rhodesia (now Zimbabwe) 372 leprosy sufferers see people with leprosy le Puiset, Hugh, bishop of Durham 99 Leviticus 56

life cycle 8 Life of Saint John Chrysostom 53 Life of Saint Zôticos 53, 54 Liutprand of Cremona 56 living conditions 51, 361, 363, 365 Livre au Roi, legal code for the kingdom of Jerusalem 302 London 358 dean and chapter of 102 mayor and aldermen of 111 Losting, Johan Ludvig, artist 349 Louis IX, king of France 299 Louis of Toulouse, saint 238 Louvre museum, the, Paris 253 Lucretius 46, 48 Lungegaardshospitalet (leprosy research hospital), Bergen 351 Luther, Martin, works of 230 Lyons, Council of (1274) 97 Lyons, forest of 167 Mackenzie, Morrell, Sir, physician 359 Madern, Henne, diagnosed as a leprosus 193–4 Magdalino, Paul 55 Mainz, archdiocese of 185 Maisons Dieu 147, 149 see also almshouses malaria 51 malnutrition 161, 164, 361 Manchester, Keith 26 Mansourah 299, 300 Marcellus Empiricus 48 Maria Saal, pilgrimage church of 244 Marmoutier, abbey of 82 Martin of Tours, saint 46, 50, 54, 237–8, 271, 272, 284

593

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Index martyrdom 305, 370, 371 Mary Magdalen, saint 253 Mary, the Virgin, saint 253 mass 97, 106, 114 Matos, Vitor 26 meat 166, 168 Mediterranean, the 35, 45, 223 melancholy 165 MHARP see University of Winchester, Magdalen Hill Archaeological Research Project (MHARP) miasma 31, 111, 163 Michael IV Paphlagonian, basileus 53, 54 Michael Psellos, Chronography of 54 Michelet, Jules 45 Middle East 46 milk 164 Miller, Mr, leprosy sufferer in Britain 365 Milner, John, historian of Winchester 138 miracles 8, 12, 272, 325 missionaries 95, 362, 369–70, 374 female 371 Mitchell, Piers 37 mobility 45, 50, 53, 60 Møller-​Christensen, Vilhelm  26 monasteries 11 Montferrand, consuls of 247 Month, The, Jesuit magazine 372 Montpellier 209 University of 164 Montreuil 171 More, Thomas, saint, Supplication of Souls of 115 Moulineaux, village of 170 Mühlholzer, Jakob, artist 238

395

Muir, Ernest, leprologist 361 Mulhane, L. W., Reverend, Leprosy and the Charity of the Church of 368 Munro, William, Medical Officer to Saint Kitts 353 music 215, 250 Myller, Katherine, leprosa 105 Myller, William 105 nakedness 215 Narbonne 2, 190, 280, 323 municipal government of (Consuls) 324, 326, 335 royal bailiff of 335 National Archives, the, London 365 national patient records 348, 351, 354 Netherlands, the 232, 249, 251, 352 Nevers, wine from 169 New Testament, the 273, 281 New World, the 354 Newman, George, physician 355 newspapers 358, 359, 373 Nierstein 191 Nineteenth Century, The, literary magazine 358, 359 Nona, bishop of Edessa 53 non-​naturals, the  163 Normandy 82, 133, 161 North America 35 northern Europe 35 Norway 349, 351, 352, 364, 373 Viking laws of 349 Norwich 101, 113 bishops of 104 Saint John’s Timberhill (Castle Mall), medieval church 134

396

Index

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Nuremberg 333 feast for people with leprosy 170 nutrition 360 oats 173 Oceania 35 Old English Herbarium 133 Old Testament, the 370 Orderic Vitalis 82 Oribasius 47 Origen 68 Orléans, Council of (549) 50 Orosius 48 osteology 5, 52 palaeopathology 5, 25, 26, 39 papacy, the 295 Paris 46, 51, 241 Paris, Matthew 351, 366 Chronica Majora of 299 manuscript illustrations in 308 Pas-​de-​Calais, region  161 people with leprosy agency of 12, 170, 183, 195, 330, 374 attitudes to 323 begging by 171, 235, 249 bodily care of 166 burial of 6, 36–7, 38, 134, 141, 154, 305 cleansing of 230 exclusion of 243, 332, 337, 347 freedom of movement of 170, 187 healing of 232 holy status of 58 identities of 1, 3, 34, 155, 184, 315, 332, 336 retaining previous identities 168

informal communities of 189–91, 230, 328 Heilig Kreuz, Mainz 189 see also leprosy, medieval, extra-​institutional contexts integration of 11, 12, 38, 97, 101, 191, 195, 256, 315 itinerant 230, 246, 248, 328 see also leprosy, medieval, extra-​institutional contexts kissing of 11, 12, 50, 237, 270, 271, 272, 275, 277, 281, 284, 370 legal arrangements for 302 persecution of 350, 354 1321 ‘Lepers’ Plot’ 241 professed religious 98, 168, 194 regulation of 11, 332–6 responses to 286 dichotomy in 67, 83, 84 repulsion 275, 281 segregation of 11–12, 74–80, 155, 302, 304, 348, 350, 354, 356, 359, 360, 362, 368, 374 skeletal remains 25, 31 social status of 142, 166 spiritual care of 166 uniform of 103, 187, see also clothing vocal capacity of 227, 247 voices of 12, 335 washing of feet of 238, 282 periodicals 359 Pescia 235 Peterson, Anna M. 2, 3, 7, 9, 11, 184, 190 Petrus, leprosus of the leprosy hospital of Saint Laurence of the Cité, Narbonne 329

793

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Index Peyroux, Catherine 272 philanthropy see charity Philippe V, king of France 241 physicians 191, 193, 237, 331 Pierzivallus, diagnosed leprosus of Siena 331 pigs 167 pilgrimage 56, 104, 143 pilgrims 230, 295, 305 Pistoia 237 plague 4, 5, 45, 51, 105, 111, 132, 174, 355 Pliny, the Elder 46 Pliny, the Younger 48 Poitiers 272 policing 333 Pontoise 169 Poore, Richard, bishop of Salisbury 96 pork 164, 165, 172 Portugal 352 pottery 140, 143, 151 poultry 165 poverty 24, 35, 215, 235, 310 religious 273, 274 pox see French disease, the prisoners 174 processions (religious) 113, 253 public health 12, 97, 174, 191, 327, 334, 355 public works 110, 115 purgatory 104, 270 purification 73–4, 83 Quintus Serenus 48 race 365, 374 Radegund, saint 271, 272 radiocarbon dating 134, 143, 149 Raimundus, leprosus of the leprosy hospital of Saint

397

Laurence of the Cité, Narbonne 329 Rawcliffe, Carole 7, 11, 327 Raynone Infectus, administrator of the leprosy hospital of San Lazaro, Siena 330 Reformation, the 230 relics 109 Renaldus, benefactor of the leprosy hospital of San Lazaro, Siena 327 Rhabanus Maurus, De Rerum naturis of 52 Rhineland, the 183 Richard of Saint-​Victor, De Potestate ligandi et solvendi of 83 Riemenschneider, Tilman, artist 238 Rigaud, Eudes, archbishop of Rouen 166, 167 Robert I, count of Artois 299 Robert, count of Zerdana 301 Robert of Flamborough, theologian 103 Robert, patriarch of Jerusalem 5 Roberts, Charlotte 2, 4, 6, 7, 163, 220, 229 Robert the Pious, king, meeting with leprosy sufferers 57 Roffey, Simon 4, 6, 7, 8, 11 Roger de Fraxineto, constable of Henry II of England 100 Roger, canon of La Madeleine hospital, Rouen 167 Rogers, Sir Leonard, leprologist 361, 366 Roman Empire, the, collapse of 50 Roman of Jaufré, the 69 romances 185 Romanus of Condat, saint 272 Rothenburg an der Tauber 238

398

Index

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Rouen 328, 333 butcheries at 164, 174 Rufus of Ephesus 47 rumour 71 Russia 352 Saint Francis Leprosy Guild, the 370 Saint John, crusading order of rule of 303 Saint Lazarus, crusading order of 9, 10, 111, 368 healthy knights of 297 identity of 313 leprous members of 297, 305, 309 military role 304 master of 306 military activity of 295, 297, 307 rule of 297, 312 seals of 309–15 Saint Martin, Tours, monastery 56 Saint Mary Magdalen, Winchester, leprosy hospital excavation of 136 financial difficulties of 147 high incidence of leprosy at 142 leprosy hospital 4, 8 material objects excavated at 151 origins of 137–8 Saint Mary of Portiuncula, Assisi 282 Saint Pierre, Moissac, abbey 221 Saint Thomas, crusading order of 296 Saint-​Etienne, Caen, abbey 133 Saint-​Omer  171 Saint-​Ouen, Rouen, abbey 168 saints 270, 370, 372 salt 172

sanctity 271 sanitation 360 Santiago de Compostela, shrine of Saint James 222 pilgrim badges from 143 scabies 52, 165 scandal 83 Scandinavia 356 Schnebbelie, Jacob, artist 138 Science Museum, London 218 Scribonius Largus 48 seals 53, 297, 309–15 see also Saint Lazarus, crusading order of, seals of Sebastian, saint 215 Seffrid, bishop of Chichester 102 segregation see people with leprosy, segregation of sermons 185, 285 Severin, saint, Life of 51 sex workers 327 Sidonius Apollinaris 70 Siena 2, 11, 190, 237, 323 Biccherna of 333 Consiglio Generale of 330, 331 Constituto of (1262) 324–326, 331, 333, 334 municipal government of (Commune) 324, 326, 332 podestà of 331 Simpson, James Young, physician 352 Skinner, Patricia 71 slave trade, the 354 smallpox 51 Snyder, Rupert, diagnosed as a leprosus 192 social status 37, 39 South America 35 southeast Asia 21

993

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Index standards of living 50 Stemmle, Jennifer 107 Stephen, king of England 104 stigma 164, 244, 269, 347, 364, 370 see also leprosy, Hansen’s disease, stigma; leprosy, medieval, stigma Stratford, Ralph, bishop of London 111 suffering 369, 371 emotional 370 iconography of 211 Sulpicius Severus, Life of Blessed Martin of 238 Sunieve, Richard 80 Switzerland 352 syphilis see French disease, the Tangmere, Henry, of Cambridge 113 Templars, crusading order of 295, 298, 299 rule of 303 Terçorini, Guido 325 Tertullianus 68 testaments see wills Teutonic Order, crusading order 296, 298, 299 rule of 303 Theodore of Petra 53 Theodosius the Cenobiarch, saint 52 Thomas Becket, saint, archbishop of Canterbury 8 as martyr 73 miracles of 12, 68, 75–8, 80 Thomas of Celano, hagiographer of Saint Francis Vita prima 274, 276–7 Vita secunda 275, 278–80

399

Thomas of Monmouth, chronicler 98 Thurstan, archbishop of York 109 Times, The, newspaper 370 Toclyve, Richard, bishop of Winchester 138 Toli, Thomas, of Gloucester 104 Touati, François-​Olivier 2, 3, 108, 183 Toulouse 246 Tours 226, 238 Traité des eaux artificielles, the 165 tropics, the 357, 364 tuberculosis 5, 31, 32, 36, 51, 132 Turner, Sir George, leprosy sufferer 371 Tuscany 237 Uganda, British protectorate of 369 Umar, caliph 60 United States of America 361 University of Winchester, Magdalen Hill Archaeological Research Project (MHARP) 136 Urban IV, pope 296 Ursel 193 Valor Ecclesiasticus, the 152 van Meckenem, Israel, artist 218 veal 167 Vegetius 48 Virchow, Rudolf 210, 215, 349, 352 visitation records, episcopal 165, 166 Vollset, Magnus 2, 5 von Eberscheim, Henne, leprosus 188 Vongsathorn, Kathleen 2, 5 von Soest, Conrad, artist 227

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400

Index

Walkelin, bishop of Winchester 133 walking aids 214, 224, 236 Walter of Novo Castro, master of the Order of Saint Lazarus 296 warfare 296 waters, medicinal 165 Wellcome Collection, London 218 Wellcome, Sir Henry S. 218 wells 137, 171 Wellys, Henry, of Norwich, leprosus 101 wheat 167, 173 white cheese 172 Willem VI, count of Haarlem 254 William of Auxerre 82 William of Canterbury 12, 70 William of Norwich, boy martyr 98 William, son of Droco from Argentan 72

wills 113, 149, 150, 171, 326, 327, 333 Winchester medieval fair of Saint Giles 137 wine 164, 165, 166, 168, 169 Winton Domesday, the 138 Wixhuser, Heinrich 192–3 Wolvesey Palace, Winchester 145 works of mercy, the 133, 161 Wright, Henry Press, archdeacon 358, 360, 368 Wykeham, William, bishop of Winchester 149, 150 Yates Thompson, Henry, newspaper proprietor and manuscripts collector 224 York 37, 113 butchers of 174 Zambaco Pacha, Demetrius, physician 357