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

By Manchester University Press

For the first time, this volume explores the identities of leprosy sufferers and other people affected by the disease in medieval Europe. The chapters, including contributions by leading voices such as Luke Demaitre, Carole Rawcliffe and Charlotte Roberts, challenge the view that people with leprosy were uniformly excluded and stigmatised. Instead, they reveal the complexity of responses to this disease and the fine line between segregation and integration. Ranging across disciplines, from history to bioarchaeology, Leprosy and identity in the Middle Ages encompasses post-medieval perspectives as well as the attitudes and responses of contemporaries. Subjects include hospital care, diet, sanctity, miraculous healing, diagnosis, iconography and public health regulation. This richly illustrated collection presents previously unpublished archival and material sources from England to the Mediterranean.

• Language: English
• Publisher: Manchester University Press
• Release date: Apr 13, 2021
• ISBN: 9781526127440

Book preview

Leprosy and identity in the Middle Ages

SOCIAL HISTORIES OF MEDICINE

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

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

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

Typeset by Newgen Publishing UK

Contents

List of figures

List of tables

Notes on contributors

Acknowledgements

List of abbreviations

Introduction – Elma Brenner and François-Olivier Touati

Part I: Approaching leprosy and identity

1Reflections on the bioarchaeology of leprosy and identity, past and present – Charlotte Roberts

2Lepers and leprosy: connections between East and West in the Middle Ages – François-Olivier Touati

3The disease and the sacred: the leper as a scapegoat in England and Normandy (eleventh–twelfth centuries) – Damien Jeanne

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

5Saint Mary Magdalen, Winchester: the archaeology and history of an English leprosarium and almshouse – Simon Roffey

6Diet as a marker of identity in the leprosy hospitals of medieval northern France – Elma Brenner

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

7Good people, poor sick: the social identities of lepers in the late medieval Rhineland – Lucy Barnhouse

8The clapper as ‘vox miselli’: new perspectives on iconography – Luke Demaitre

Part IV: Religious and social identities

9Kissing lepers: Saint Francis and the treatment of lepers in the central Middle Ages – Courtney A. Krolikoski

10From pilgrim to knight, from monk to bishop: the distorted identities of leprosy within the Order of Saint Lazarus – Rafaël Hyacinthe

11Connotation and denotation: the construction of the leper in Narbonne and Siena before the plague – Anna M. Peterson

Part V: Post-medieval perspectives

12‘Our loathsome ancestors’: reinventing medieval leprosy for the modern world, 1850–1950 – Kathleen Vongsathorn and Magnus Vollset

Index

Figures

1.1Skull 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.

1.2Damage 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).

1.3Twenty-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.

1.4The 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.

2.1The early-ninth-century ivory panels of the Andrews Diptych, Victoria and Albert Museum, London (A.47&A-1926). Image © Victoria and Albert Museum, London.

5.1View of the excavations of Saint Mary Magdalen, Winchester, looking west towards Winchester. Photograph: Simon Roffey.

5.2Interior 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.

5.3Excavations of the east end of the chapel of Saint Mary Magdalen, Winchester, looking south. Photograph: Simon Roffey.

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

5.5View 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.

5.6Pilgrim burial with in situ scallop shell from Saint Mary Magdalen, Winchester. Photograph: Simon Roffey.

5.7Excavation of the twelfth-century masonry hall, probably an infirmary, at the leprosarium of Saint Mary Magdalen, Winchester (looking north-west). Photograph: Simon Roffey.

5.8West end of the medieval infirmary at Saint Mary Magdalen, Winchester. Photograph: Simon Roffey.

8.1Jesus 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).

8.2Bishop 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, MS Royal 6 E VI [Vol. II], fo. 301.

8.3The 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).

8.4A ‘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.

8.5People 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.

8.6Three 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.

8.8Provenances of 150 continental images with clappers.

8.9Themes of 150 continental images with clappers.

8.10Dives 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.

8.11Dives 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.

8.12Dives 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.

8.14Christ and the Ten Lepers. Miniature in Vita Christi, Bruges, c. 1485. New York, Morgan Library, MS M.894, fo. 112r.

8.15Jhesu 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.

8.16Saint 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.

8.17Saint Martin kisses a leper. Coloured drawing, western France (Tours), third quarter fourteenth century. Tours, Bibliothèque municipale, MS 1018, fo. 36v. © Bibliothèque municipale de Tours.

8.18Saint 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.

8.19Meseaux 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.

8.20A 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.

8.21A 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.

8.22H[eilige] Lazerus. Polychrome wood statue, second quarter of the sixteenth century, Lazaruskapel, Rumst, Prov. Antwerp, Belgium. Flamenc/Wikimedia CC BY-SA.

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

10.1Nineteenth-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.

10.2Nineteenth-century drawing of a seal of the Order of Saint Lazarus dating to 1287 and showing a seated bishop with the legend ‘EPISCOPVS LAZARVS’. Reproduced from A. Nuscheler, ‘Die Lazariterhäuser im Gfenn bei Dübendorf und Schlatt’, Mittheilungen der antiquarischen Gesellschaft in Zürich, 9 (1856), Plate 2.

10.3Nineteenth-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.

10.4Nineteenth-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.

Tables

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

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

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 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.

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 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).

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).

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.

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.

Abbreviations

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.

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 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

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 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 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 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 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 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,