Medieval leprosy reconsidered.
Subject: Leprosy (History)
Authors: Miller, Timothy S.
Smith-Savage, Rachel
Pub Date: 03/22/2006
Publication: Name: International Social Science Review Publisher: Pi Gamma Mu Audience: Academic Format: Magazine/Journal Subject: Social sciences Copyright: COPYRIGHT 2006 Pi Gamma Mu ISSN: 0278-2308
Issue: Date: Spring-Summer, 2006 Source Volume: 81 Source Issue: 1-2
Topic: Event Code: 290 Public affairs
Geographic: Geographic Scope: Europe Geographic Name: Europe; Europe Geographic Code: 4E Europe
Accession Number: 148857228
Full Text: Historians recognize that during the High Middle Ages--from shortly after 1000 to 1300 A.D.--Western Europe experienced a period of unparalleled growth. Populations tripled; first schools and then universities flourished; new cathedrals rose up in many cities; and, commerce and manufacturing had been revitalized on the Italian peninsula and gradually spread throughout Western Europe. Ironically, this period also witnessed an unprecedented outbreak of leprosy in the region, a disease that could be horribly disfiguring, but fortunately did not have a significant impact on demographic growth.

This leprosy "epidemic" and the attempts of Latin Christian society (Roman Catholic Europe) to deal with the health problems it created have attracted the attention of experts in the history of medicine and cultural historians. (1) Unfortunately, some of these scholars have failed to read the medieval sources in their proper contexts, sources that describe both the outbreak of leprosy and the organization of leprosaria, the medieval hospices designed to care for victims of the disease. This has caused some of them to misrepresent medieval Christianity's response to leprosy as an attempt to punish victims of the disease rather than to assist them in their suffering.

Most studies published in English during the past thirty years have focused on evidence from Latin Europe during the time of the leprosy epidemic beginning ca. 1100 A.D. To understand the Latin sources of the High Middle Ages properly, one must study them together with the Greek sources of the patristic age (300 to 500 A.D.), a period during which the Early Byzantine Empire experienced an outbreak of leprosy similar to that which occurred in England, France, Italy, and Germany in the two centuries following the First Crusade (1099). Accordingly, this study will first describe what modern medical science has discovered concerning leprosy. It will then review some of the opinions historians have expressed regarding how medieval society viewed leprosy and treated its victims. Lastly, it will examine primary sources and reinterpret the evidence they present in the wider context of Christian society as a whole.

In 1873, the Norwegian scientist, Armauer Hansen, correctly identified Mycobacterium leprae as the bacterium which causes leprosy. Although Mycobacterium leprae exists in only one strain, leprosy can appear in several forms depending upon how effectively the human hosts' biological defenses combat the infection. In its most extreme form, leprosy causes skin lesions and raised tumors, disfigurement of the face, and even loss of fingers and toes. These horrific symptoms doubtless explain why ancient and medieval societies often forced lepers to live in isolation from communities. In its less severe manifestations, however, leprosy can be confused with other skin diseases. In fact, the leprosy of ancient Israel, described so vividly in the Old Testament, was certainly not the disfiguring disease caused by Mycobacterium leprae, but a milder form of skin allment. True leprosy seems to have first appeared in the Mediterranean basin during the Hellenistic period and to have become especially well-established in Egypt by the time of the famous Greek physician Galen (129-200 A.D.). Modern science also has proven that leprosy is contagious as ancient and medieval societies suspected. Most people, however, possess a natural immunity to the disease. Thus, leprosy does not sweep through a society killing millions in a few months. It affects only a small number of people (five to ten percent of the population) whose bodies cannot resist Mycobacterium leprae. (2)

Several recent influential books have reexamined medieval leprosy. Each of these studies emphasize that Christian Europe's response to lepers reflected a more general program to identify and isolate alien elements in society. In his popular history of medicine, Roy Porter briefly discusses the leprosy epidemic of the High Middle Ages. He claims that the medieval Church excluded lepers from society by imprisoning them in leprosaria and then justified this harsh treatment by depicting leprosy as punishment for one's sins. Porter also emphasizes how ecclesiastical leaders portrayed leprosy as a living death and even developed a special religious service for lepers that simulated a funeral mass. The victims of leprosy were dead to the world, and in their seclusion they should remain as separate from the healthy as the deceased were from the living. (3)

In a fascinating monograph on epidemic diseases, Sheldon Watts, another historian of medicine, examines the political, cultural, and economic implications of disease. In his chapter on leprosy, Watts interprets the medieval sources much as Porter does. (4) Watts begins by identifying the ancient Greek physician, Aretaios of Cappadocia, a contemporary of Galen, as the first writer to provide an accurate description of true leprosy. Subsequently, Christian Western Europe lost the enlightened tradition of Greek physicians such as Aretaios whose writings and scientific outlook managed to survive only among Muslim physicians. According to Watts, the Latin Christian world depended on the Jewish Old Testament for its understanding of leprosy. The Law of Moses excluded lepers from the camp of Israel because of their impurity. As Watts concludes, "On this foundation (the Christian exegesis of the Mosaic Law) would be built the conviction that leprosy was God's punishment for sin and that lepers must be driven out of the camp." (5)

Watts also describes how the leprosy epidemic of the High Middle Ages resulted in the proliferation of leprosaria, especially in France. By the 1220s, Paris alone had forty-five leprosaria and Europe as a whole possessed several thousand. (6) According to Watts, these leprosaria actually served as detention centers for people whom the local elite--both church hierarchs and lay rulers--considered potential trouble-makers. People were accused by informants of having contracted leprosy, tried by panels representing the local bishop and secular authority, and then incarcerated in leprosaria. As Watts explains, no medical experts sat on these examining boards. When during the fourteenth century physicians secured seats on these juries, the number of real lepers, identified by these procedures, dwindled, and the leprosy epidemic suddenly ended, an epidemic which Watts asserts had been fabricated. In other words, Watts maintains that medieval leprosy was a construct disease--i.e., a disease invented by those in power to secure their political, cultural, and economic dominance. (7) Much of Watts' account of medieval responses to leprosy reinforces widely-held views that Christian society isolated lepers as symbols of sin as well as bearers of a contagious disease. His assertion that the leprosy epidemic was purely a tool of political oppression, however, has not found wide support primarily because of convincing archeological evidence (see below) that many lepers were buried in leprosaria cemeteries.

A third book, Mending Bodies, Saving Souls, by physician and medical historian Guenter Risse, focuses on the history of hospitals and devotes a chapter to the medieval leprosy outbreak and the foundation of leprosaria. In agreement with Watts, Risse identifies France as the center of leprosaria construction. The will of King Louis VIII (who died in 1228) suggests that the French realm had 2,000 leper hospitals. Risse also accepts the view that the church enforced segregation of lepers because of their supposed sinfulness. Although Risse echoes many of the arguments presented by Porter and Watts, he offers two new observations. First, he emphasizes how those who founded leprosaria also drafted regulations for daily life in their institutions, regulations that were patterned on monastery rules. These leprosarium regulae required that lepers wear a habit similar to those worn by monks and spend some time as novitiates before gaining formal acceptance within the leprosarium. These rules also outlined fasts and even expulsion from the community as punishments for disobedience and misconduct, regulations which cast doubt on the role of leprosaria as institutions for confining society's undesirables. Second, some of the leprosaria became wealthy through large endowments and provided those lepers in their care with a comfortable life. (8)

In The Formation of a Persecuting Society, a book which influenced the works of Watts and Risse, medieval historian Robert I. Moore maintains that leprosaria might have begun as charitable institutions, but they evolved into tools to isolate lepers and persecute them. Moore views the incarceration of lepers as part of a European-wide movement to identify and persecute minority groups, not only lepers, but Jews and various Christian heretics as well. (9) Although much of what Moore claims about medieval society's response to leprosy represents mainstream views, his comparison of lepers to religious non-conformists remains controversial because most scholars have not seen a clear parallel between isolating supposed victims of a contagious disease with the repression of heretics.

Porter, Watts, Risse, and Moore all rely on perhaps the best and most complete discussion of medieval leprosy in English, historian Saul Brody's The Disease of the Soul. Brody's monograph focuses on the image of leprosy in medieval literature, but it also provides an excellent overview of the entire history of the disease from its arrival in the ancient Middle East until its disappearance in the late Middle Ages. Brody's careful examination of medieval romance literature proves that leprosy was often viewed as a symbol for sin.

Brody first summarizes the German romance, Der arme Heinrich (Poor Henry), written by Hartmann yon Aue just before 1200. Heinrich, the hero of the story, was the perfect knight--brave in battle, handsome in appearance, and intelligent in conversation--but his personal gifts had filled him with pride. As a result of his arrogance, God struck him with leprosy. Heinrich sought a cure from the best doctors in Christendom and even visited Salerno, twelfth-century Europe's most famous medical school. There a learned physician told him that only the blood from a virgin's heart could cure him, a virgin who would willingly give up her life for him. Heinrich eventually won the love of a pure peasant girl who was willing to offer her life to restore his health. God, however, cured Heinrich only when the knight demonstrated that he loved the girl more than he valued his own health. (10)

Brody also analyses a later English romance, Robert Henryson's Testament of Cresseid (1507). In this story, Cresseid's lover Troilos rejected her in favor of the beautiful Diomedes. In her bitterness, Cresseid turned to a life of pure pleasure, filled with sexual excesses. The gods punished her lust by striking her with leprosy, which in this story clearly symbolizes sin, the leprosy of the soul. (11)

Unlike Porter, Watts, and Risse, however, Brody stresses that medieval people not only saw leprosy as a mark of sin, but they also interpreted it as a sign of God's blessing. In 1239, the bishop of Tournai called the disease a special gift from God. Continuing an ancient Christian tradition from Greek patristic times, some medieval authors called it the holy disease. Other authors related it to the suffering of Lazarus, the poor man in Luke's gospel who went immediately to heaven upon his death. Finally, medieval Christians believed that Jesus frequently appeared in the form of a leper to show his solidarity with the most humble of people. (12)

Stephen R. Ell, another historian of medicine, repeats many of the assertions discussed above in his article on leprosy in The Dictionary of the Middle Ages, a standard reference work for both general readers and medievalists. He writes:

As this study will demonstrate, Ell's statements ignore medieval society's strong impulse to assist lepers, an impulse clearly inspired by the Christian tradition.

Having reviewed these well-known monographs and Ell's encyclopedia article, we shall now examine primary-source evidence regarding medieval leprosy to emphasize some different perspectives on how Christians viewed the disease and treated those who suffered from it. This requires a careful reading of medieval Latin texts in the light of earlier Byzantine texts of the fourth and fifth centuries and of important archaeological evidence--the skeletons of leper victims.

Modern pathological research has demonstrated that advanced leprosy not only attacks skin tissue, but it eventually corrodes the bone around the oral and nasal cavities and scars finger and toe bones. By examining skeletal remains from leprosarium cemeteries, archaeologists can determine which skeletons show signs of the disease and thus estimate how many residents in leper hospitals actually suffered from this illness. (14)

Using this method of research, Vilhelm Moller-Christensen has found that in the Danish cemetery at Naestved, a leprosarium which functioned from 1250 to 1550, seventy percent of the 500 skeletons studied showed clear signs of leprosy. When one considers that autopsies on modern leper victims have confirmed scarring on the bones of only fifty-four percent of the cases and that non-leprous staff members at leper hospitals also were buried in the leprosarium cemeteries, Moller-Christiansen's research casts serious doubt on Watts' claim that few residents in medieval leper hospitals actually suffered from the disease. (15)

In his book, Watts mentions Moller-Christensen's research, but he dismisses it because the Naestved leprosarium lay beyond the heartland of Medieval Europe. (16) Watts, however, ignores the research of Egon Schmitz-Cliever who excavated the cemetery of the Melaten leprosarium outside Aachen in the heart of Western Europe. Schmitz-Cliever examined the skeletons of forty people buried between 1230 and the early 1500s; only three did not show leprous markings on their bones. (17)

Turning from archeological evidence to written primary sources, one finds that modern scholars have often failed to understand the earlier Greek texts in their proper historical context. As a consequence, they have not related them correctly to later statements on leprosy in the Latin documents of the High Middle Ages. We shall begin by examining the observations of leprosy made by Aretaios, the ancient Greek physician who wrote ca. 150 A.D. what Watts, Risse, and Brody identify as the first accurate description of the disease. Aretaios mentioned the blotches and fissures of the skin, the discoloration of the complexion, and the loss of fingers and toes. He also claimed that the cause of leprosy was the same physical process as that which causes death.--i.e., a cooling of the body through the rising of the cool and dry humor (one of the four basic fluids of the body according to ancient Greek medical theory) called black bile. According to Aretaios, the hair of lepers fell out and then their fingers and toes dropped off as the remoter parts of the body died. Aretaios explained that leper victims did not immediately experience full death, but suffered a long debilitating state between life and death. (18)

It is important to notice that Aretaios, a Greek medical scientist, first described leprosy as a kind of living death. Two fourth-century Christian writers--Gregory of Nazianzos and an anonymous biographer of John Chrysostom, bishop of Constantinople from 398 to 405--adopted this image and used it to arouse sympathy for lepers. (19) Since the writings of Gregory of Nazianzos were extremely popular, that image would he embraced by later Byzantine and Latin writers. (20) Thus, the idea that leprosy was a form of living death did not derive from Christian interpretations of the Old Testament, but ultimately from Greek scientific writers, those enlightened scientists whom Watts claims only the medieval Islamic world studied and preserved. (21)

It is now useful to consider a second category of primary-source documents--Greek patristic texts from the fourth and fifth centuries--which modern studies of medieval leprosy have often ignored or misunderstood, especially as they relate to later Latin views on leprosy. Perhaps the most influential ancient physician, Galen, had stated in the second century that leprosy flourished especially in Egypt, a province in the eastern, Greek-speaking half of the Roman Empire. From Egypt leprosy spread to Palestine, Syria, and Asia Minor. (22) As these eastern provinces became predominantly Christian after the emperor Constantine's conversion to Christianity ca. 312, bishops in these areas began to address the subject of leprosy because the disease was now spreading rapidly in these regions. Gregory, bishop of Nyssa in Asia Minor during the 370s, delivered a fascinating sermon on leprosy which clearly stated that the disease had recently become much more common in Cappadocia. Although Gregory of Nyssa's sermon focused on moral and religious issues, he presented perhaps an even better clinical description of leprosy than had either Aretaios or Galen. Gregory of Nyssa mentioned all the symptoms that Aretaios had identified, but he added a raspy voice, and most importantly, the loss of sensation in the affected skin. This loss of feeling later became the key to distinguishing leprosy from other skin ailments. Gregory of Nyssa also described how people rejected lepers, expelling them from marketplaces, public baths, cities, and even their family homes. He stressed, however, that Christ expected his followers to help these most wretched of human beings. By accepting lepers, by feeding them, by embracing them, even physically, Christians merited salvation. Gregory of Nyssa also tried, by using a scientific argument, to convince his congregation not to reject lepers. According to the bishop, the disease was not contagious because one could not contract the humoral imbalance--excess black bile in the blood--that caused leprosy by contact with a person infected with the disease. Preserving one's health, therefore, did not require that an individual avoid lepers, nor did society as a whole need to banish from populated areas those who had contracted this disease. (23)

Another Gregory, bishop of Nazianzos, and a friend of Gregory of Nyssa, wrote an even more extensive treatise on lepers and their illness. He composed this essay as a sermon on the Christian obligation to assist victims of the disease. Gregory of Nazianzos specifically condemned those people--whether pagans or Christians--who justified rejecting lepers because God had sent this disease to punish them. Gregory of Nazianos argued that the Book of Job taught Christians that it was impossible to comprehend why God acts as He does. Gregory of Nazianzos believed that Job himself had suffered from leprosy and thus served as an example of how good people must frequently bear great evils, but Christians should not dare to claim that they fathom why God permits some to fall ill and others to remain healthy. (24)

John Chrysostom, another leading figure in Greek patristic literature, also addressed the issue of leprosy while he served as bishop of Constantinople (395-404). During his episcopacy, he began construction of a large leprosarium outside the capital. He planned this institution not to isolate lepers, but to give them a healthy place to live near a river, and to offer them all the benefits of a home and of communal life. The traditional Greco-Roman citystates (poleis), not yet fully Christianized in the late fourth century, had taken these benefits away from lepers. John Chrysostom never thought of the leprosarium as confinement, but as an institution of comfort for those deprived of the benefits of the polis community. (25)

Almost forty years later, Cyril, the famous bishop of Alexandria from 412 to 444, further elaborated the Christian view of leprosy when he wrote a significant commentary on the Mosaic Law's regulations regarding leprosy. On the one hand, the Old Testament banned lepers from the camp, but on the other hand, it provided a complicated set of rituals including the sacrifice of a dove which a leper should perform if he/she were healed and sought readmission to society (an indication that Old Testament leprosy was not what Aretaios, Galen, and subsequent medieval society identified it as a disease which was incurable). Cyril stressed that Christians should never interpret these Old Testament laws literally because it would be an evil act to ban lepers from society; these people deserved mercy, not rejection. Rather, Cyril interpreted the passage allegorically: leprosy was sin and the sacrificed dove Christ's saving death on the cross. (26)

Cyril's treatise reinforces the point made by both Gregory of Nyssa and Gregory of Nazianzos, namely that Christians should not reject the victims of leprosy, but assist them. It also shows how leprosy came to represent sin. In the Greek-speaking Christian world which evolved into the Byzantine Empire, bishops, monks, and lay people were able to distinguish allegory from reality. Although Byzantine writers continued to describe sin as spiritual leprosy, such allegorical language had no effect on the actual treatment of lepers. A twelfth-century jurist of Constantinople, Theodore Balsamon, observed how Byzantine society allowed lepers access to the same churches, cities, and assemblies that healthy people attended. (27) Were Latin-speaking Christians also able to distinguish symbol from reality?

In the Western Roman Empire--the Latin speaking provinces of Italy, Gaul, Spain, and North Africa--leprosy also began to claim more victims by the late fourth century. In a letter written before 400, Saint Jerome--a monk and priest of the Roman Church--praised a wealthy widow named Fabiola, a resident of Rome, for her many charitable activities. Jerome believed that her outstanding act of charity was constructing a hospital in Rome for those with distorted feet, inflamed complexions, and truncated noses, people whose blood had become turgid, i.e., muddy with the black bile of leprosy (the cause of Aretaios' living death). Fabiola built her leprosarium for these dying people, and even personally served them by washing their oozing flesh. As in the sermons of the two Gregories, Jerome portrayed the care of lepers as the greatest act of Christian charity. (28)

Outside of Rome, few references to leprosy survive from the Western provinces until 539 when the bishops of Gaul met in a synod at Orleans. Here the bishops approved a number of canons to regulate Christian life in the new political world of German dominance. One of these canons stated that Christian piety required that the bishop of each city provide lepers with food and clothing from the resources of the local church. At a later synod held in Lyons in 583, the bishops reaffirmed that they themselves should assist lepers but added that leprosy victims should receive aid only in the cities where they had permanent residence and should not wander from place to place. The synod of Lyons thus enacted the first restrictive regulation against lepers found in our research of primary sources. (29)

By the end of the sixth century, some bishops in Gaul had set up permanent institutions to house and feed lepers. Bishop Gregory of Tours mentioned one such leprosarium at Cabillonum, the modern Chalon-sur-Sa6ne. Ca. 550 Cabillonum's Bishop Agricola had built just outside the town an institution that Gregory of Tours described as a xenodochion (hospice in Greek) for lepers. Gregory of Tours did not provide any details on how this leprosarium functioned, but he did refer to a church attached to the hospice which was large enough to hold a grand assembly of local abbots and clergymen. (30)

One should notice that Gregory of Tours chose a Greek word xenodochion for Agricola's leprosarium. Jerome had employed another Greek term nosokomeion (hospital for the sick) in referring to Fabiola's refuge at Rome. As Galen had noticed, leprosy was especially common in Egypt and the Eastern provinces of the Roman Empire and rare in Germany and the North. The Latin sources reviewed here also suggest that leprosy and methods to assist its victims began in the East and then moved West.

During the sixth and seventh centuries, sources from Frankish Gaul and contemporary Italy occasionally refer to leprosy. During the eighth century, however, references to the illness became even rarer. The Carolingian rulers, Pepin III and his illustrious son Charlemagne, mention the disease in their cartularies, but thereafter, references to leprosy and to leprosaria almost disappear from West European sources until the epidemic of the twelfth and thirteenth centuries described by Porter, Watts, Risse, Moore, and Brody. (31)

Most scholars agree that the Crusades caused the return of leprosy to Italy, France, England, and Germany in the High Middle Ages. The crusaders apparently contracted the disease in Palestine after 1098 and then carried it back to Western Europe on their return home. This would explain the sudden reappearance of leprosy in the twelfth century and also its concentration in France, the primary recruiting ground for Christian warriors against Islam. As Porter, Watts, Risse, Moore, and Brody each emphasize, the chief response of Western Christian society during the High Middle Ages to the spread of leprosy was to support leprosaria, but as this study demonstrates, these institutions had a long history stretching back to the Greek Christian fathers of the fourth and fifth centuries, institutions which were clearly not meant to confine lepers or punish them for their alleged sins.

Numerous collections of regulations survive from the French leprosaria of the twelfth and thirteenth centuries and provide much information on how the lepers lived their daily lives in these hospices. As a consequence, far more information is known about Western European institutions than about leprosaria supported by John Chrysostom in Constantinople or by Bishop Cyril in Alexandria. It is therefore helpful to examine a few of these regulations to see how leper hospices of the High Middle Ages treated those infected with the disease. (32)

The bishop of Montpellier (Southern France) together with the local count approved one of the oldest surviving regulations in the 1150s for the town's leprosarium. These rules required that lepers who wished to enter the leprosarium surrender their property (one would assume movable property) upon entering the community. After a ten-day period, lepers had to decide whether to join the community. If some decided to leave, they received back their belongings and were free to reenter the secular world. The leprosarium did not force the sick to stay. Once members of the community, lepers were now required to attend church services each day and to pray for the benefactors of the community. These statutes include few details concerning organization; they mention only that the lepers--always referred to as brothers and sisters (the hospice accepted both men and women)--should obey the administrators, but provide no indication of who these administrators were or how they were chosen. (33)

The statutes of the leprosarium at Lille in Northern France provide additional evidence that medieval leprosaria were not designed to imprison lepers or to punish them in any way. Walter, Bishop of Tournai, approved these rules in 1239. In his introduction, in fact, Walter declared that leprosy had come from God as a special gift because through leprosy God was calling the sick to holiness. In his balanced account, Brody cites this passage to demonstrate how medieval people interpreted leprosy as both a curse and a blessing. (34) The rules of Lille did include restrictions on the behavior of lepers: they should not leave the leprosarium without permission; when they did leave, they should always travel in pairs; and, there should be no private conversations between women and men. Such regulations, however, were the same for contemporary monks and friars who were considered members of medieval society's First Estate. The rules also mentioned that the leprosarium had a gate which opened onto a piazza and that houses stood across the square opposite the hospice entrance. Thus, the founders had not located this leprosarium in a remote location, isolated from other dwellings. These statutes mention only two officers in the community: a magister and a priest chaplain. The rules of Lille say nothing about how to select these officers. (35)

The statutes of the leprosarium of Brives, issued in 1259, for a hospice in the Loire Valley offer a more thorough explanation of organization. They required that the brothers and sisters elect their magister and stipulated that he should be a leper himself. Moreover, these rules gave considerable power to the community of lepers, called the collegium. The magister was to make all major decisions affecting the institution with the advice and consent of the collegium. Even some punishments meted out to the brothers and sisters required the consent of a committee formed from the collegium. The leper community at Brives apparently functioned democratically. To be sure, the rules for conduct seem repressive by modern standards--no games, no conversations between men and women, repetitious prayers throughout the day--but again these regulations simply reflected monastic community life. (26)

In his book on Anglo-Norman medicine, historian Edward Kealey studied English leprosaria and included a commentary on the earliest regulations to survive from any leper hospital in Europe, those from Saint Mary Magdalene at Dudston (ca. 1130). In agreement with the interpretation of the French leprosaria regulae offered in this study, Kealey concludes that these Anglo-Norman rules were designed to assist lepers, not to punish or imprison them. As in the case of French asylums, lepers had to leave this institution if they refused to obey its regulations. (37)

Although Kealey did not find any evidence that the Magdelana leprosarium incarcerated its residents, Risse and especially Moore insist that French leper hospitals were designed to confine lepers. Both of these scholars stress the significance of Canon 23 of the Third Lateran Council, held in 1179 under Pope Alexander III. This canon required that leprosaria throughout Europe provide chapels and cemeteries for leper hospitals and hire leper priests to serve there. Moore interprets this canon as the decisive step in incarcerating lepers. If one reexamines the wording of this canon, however, one notices that the bishops of the council envisaged this regulation as offering a great benefit to the lepers. It not only guaranteed leprosaria their own chapels and chaplains as all monasteries had, but it exempted lepers from paying tithes to the local bishop. In fact, Canon 23 said nothing to restrict lepers' freedom to leave the leprosaria. (38)

Even a cursory rereading of the primary sources reveals that leprosaria were never designed to confine victims of leprosy. From their inception in the Greek provinces of the Late Roman Empire until they disappeared from Western Europe during the sixteenth century, leprosaria were designed to assist lepers, not incarcerate them. Upon reviewing another set of documents, however, one will see more clearly why some elements of medieval society did reject victims of leprosy.

In 643, the Lombard king Rothari issued a code of law which, although written in Latin, derived from the old Germanic customary laws of the Lombard tribe. When the Lombards had entered Italy in 568, they were among the least Romanized Germanic tribes. Some Lombard clans still practiced the ancient Teutonic religion, although most had become Christians of the Germanic Arian creed. Among Rothari's statutes, drawn up for a primitive Germanic people--only the Saxons of North Germany and Britain had less Roman influence--one dealt with leprosy.

The Lombard rule regarding lepers, Chapter 176 of Rothari's Edict (the customary name of the code) clearly did punish lepers. This regulation required that those whom the judge or the people confirmed as having leprosy had to leave the city where they dwelled and give up their own homes to live in isolation. Moreover, these people lost all control over their property as though they had died. Lepers retained only a fight to receive sustenance from the revenues of their former property which apparently lepers' heirs were to manage. (39)

Rothari's law had no subsequent effect on any ecclesiastical rulings by popes or on any decrees of church synods, but it did influence secular legislation. In 789, Charlemagne, who more than a decade earlier had conquered Lombard northern Italy and annexed it to his Frankish-Roman state, issued some new laws for his Western European Empire. Among the laws of 789, one reflected the sentiments of Rothari's statute; Charlemagne decreed that lepers "should not mix with other people." (40)

A closer parallel to Chapter 176 of Rothari's Edict appeared more than 400 years later in the North German code of customary law called the Sachsenspiegel (Mirror of the Saxons). These regulations were drawn up in the early thirteenth century, but they preserved aspects of earlier Saxon customary law. (41) The Sachsenspiegel had the force of law precisely in those northern regions of Germany which had resisted Romanization until Charlemagne's brutal conquest of the early ninth century. Echoing Lombard law, the Sachsenspiegel stipulated that lepers no longer could inherit any property. Unlike the Lombard law, however, the Sachsenspiegel allowed lepers to retain the use of the property they had owned when they first had become ill. (42)

Perhaps the most striking example of leper exclusion and loss of legal rights is found in English Common Law, supposedly the great bulwark of personal freedom that offered the English the necessary tools to resist oppressive government. In his commentary on thirteenth-century English law, Henry of Bracton stated that English law compared lepers to those who were excommunicated from the Church. The victim of leprosy had to leave society to join a leprosarium. From that time forward, a leper could not inherit property or make contracts. Like the Sachsenspiegel, Henry of Bracton mentioned that common law tradition allowed lepers to retain control of property that they had owned when they had fallen ill. (43)

Rothari's Edict, Carolingian legislation, the Sachsenspiegel, and Henry of Bracton's commentary on English Common Law either exclude lepers from society and/or impose severe restrictions on their legal rights. It should be noted that all of these codes originated in societies strongly influenced by Germanic customary law, a legal system less profoundly informed by Christian values than the Roman law of Justinian.

Christian concepts and institutions, whether in the Greek East or the Latin West, were not responsible for banishing lepers from healthy society. Balsamon testified that lepers in twelfth-century Constantinople continued to live with healthy people. (44) Thus, Greek Christian writers and preachers had apparently succeeded in convincing Greco-Roman communities of the Eastern Mediterranean to modify their initial response to isolate lepers. In Latin society of the twelfth century, however, lepers did suffer exclusion in some areas, but the concepts motivating this reaction derived from Germanic customs, not from Christian doctrine. The Christian leprosaria, branded by Watts, Risse, Moore, Brody, and Ells as places of exile, never served as prisons, but as havens of physical and spiritual support in an often hostile secular world.

To acquire an accurate understanding of leprosy and medieval society's reaction to it, one must read more carefully the primary sources, and view them in the context of medieval values, i.e., that death to the world was the highest vocation one could aspire to and that physical suffering brought salvation. Instead, too many scholars, especially those writing in English, have viewed the medieval response to leprosy as superstitious and cruel, and, as Moore states explicitly, as reflecting a general trend to persecute those who were different. The primary sources examined in this essay clearly show that such a view is incorrect.


(1) Leprosy never spread rapidly because a majority in any population group have a natural immunity to the disease. Thus, only a small number develop the severe form of leprosy called lepromatous leprosy, the stage at which the disfigurement of the face and limbs begins. For a good description of the disease and its symptoms, see Eugene Braunwald, et al., Harrison's Principles of Internal Medicine, 15th ed. (New York: McGraw-Hill, 2001), 1035-40.

(2) Keith Manchester, "Tuberculosis and Leposy in Antiquity: An Interpretation" Medical History 28 (1984):166-67; Saul N. Brody, The Disease of the Soul: Leprosy in Medieval Literature (Ithaca, NY: Cornell University Press, 1974), 21-33; Sheldon Watts, Epidemics and History: Disease, Power, and Imperialism (New Haven, CT: Yale University Press, 1997), 43-44.

(3) Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity (New York: W.W. Norton & Company, Inc., 1998), 121-22.

(4) Watts, Epidemics and History, 40-83.

(5) Ibid., 47-48.

(6) Ibid., 50.

(7) Ibid., 41 and 64. Watts' account of leprosy has been influenced by Mary Douglas, "Witchcraft and Leprosy: Two Strategies of Exclusion," Man, n.s., 26 (December 1991):723-36.

(8) Guenter Risse, Mending Bodies, Saving Souls: A History of Hospitals (New York: Oxford University Press, 1999), 179-84, esp. 181. For a summary of leprosaria rules, see the introduction to Leon Le Grand's edition of leprosaria rules. Leon Le Grand, Statuts d'hotels-Dieu et de leproseries; recueil de texts du XIIe au XIVe siecle (Statutes of Hospitals and Leposaria; Collection of Texts from the Twelfth and Thirteen Centuries) (Paris: Picard, 1901), xxv-xxix.

(9) Robert I. Moore, The Formation of a Persecuting Society: Power and Deviance in Western Europe, 950-1250 (Oxford: Basil Blackwell, 1987), 48-80.

(10) Brody, The Disease of the Soul, 147-57.

(11) Ibid., 173-75.

(12) Ibid., 101-03.

(13) Dictionary of the Middle Ages, ed. Joseph R. Strayer, et al. (New York: Charles Scribner, 1982-89), VII:549-52.

(14) Manchester, "Tuberculosis and Leprosy in Antiquity," 167-68.

(15) Ibid., 170-72.

(16) Watts, Epidemics and History, 56.

(17) Egon Schmitz-Cliever, "Zur Osteoarchaologie der mittelalterlichen Lepta," (Concerning Osteoarcheology of medieval leprosy) Medizinhistorisches 8 (1973):182-220, esp. 194-95.

(18) Aretaeus, ed. Karl Hude, Corpus medicorum graecorum (Collection of Greek Medical Authors), 2 (Berlin: In aedibus Academiae scientiarum, 1958), Liber 4.13 (pp. 85-90).

(19) Gregory of Nazianzos, De pauperum amando (oratio XIV), in Patriologiae cursus completus. Series graeca (Concerning the Love of the Poor (Oration 14), in Complete Collection of Patrology. Greek Series), ed. Jacques P. Migne, 161 vols (Paris: P.J. Migne, 1857-66), vol. 35, cols. 857-909, esp. col. 869 (leprosy as living death) [Hereafter the Patriologiae cursus completus. Series graeca cited as PG]. For the unedited life of John Chrysostom, see note 25.

(20) The works of Gregory of Nazianzos, especially his sermons, had a strong impact on Latin Christianity. See Dictionaire de Spiritualite (Dictionary of Spirituality), vol. 6 (Paris: Beauchesne, 1957), col. 966. See note 28 for Jerome's description of leprosy in Latin, a description which follows Aretaios' observations very closely.

(21) Watts, Epidemics and History, 46.

(22) Galen, Ad Glauconem de medendi methodo, in Claudii Galen opera (To Glaucon concerning the method of healing, in Complete Works of Claudius Galen) 2 (p. 142).

(23) Gregory of Nyssa, In illud quatenus uni ex his fecistis mihi fecistis (De pauperibus amandis II) (Concerning "whatever you have done for one of these, you have done for me" (Concerning the love of the poor, II)), ed. Adrian van Heck, Gregorii Nysseni opera (Complete Works of Gregory of Nyssa), vol. 9.1 (Leiden: Brill, 1967), 111-27.

(24) Gregory of Nazianzos, De pauperum amando (oratio XIV), PG, vol. 35, cols. 857-909.

(25) This description of Chrysostom's leprosarium is found in an unpublished life of John Chrysostom by an unknown author, identified by modern scholars as Pseudo-Martyrios. For the passage cited here see Parisinus graecus 1519, pp. 491-96 (folios numbered as pages) in the Bibliotheque Nationale (see Henri Omont, Inventaire sommaire des manuscripts grecs de la Bibliotheque Nationale (Summary Inventory of Greek Manuscripts in the National Library)[Paris: Alphonse Picard, 1888]. vol. 2, p. 76 [ms. 1519]). This biographical oration is of key importance for understanding the episcopacy of John Chrysostom. For a discussion of its significance and why it remains unpublished, see Claudia Tiersch, Johannes Chrysostomos in Konstantinopel (398-404): Weltsicht und Wirken eines Bischofs in der Hauptstadt des Ostromischen Reiches (John Chyrsostom in Constantinople: Worldview and Works of a Bishop in the Capital of the East Roman Empire) (Tubingen: Mohr Siebeck, 2000), 14-18.

(26) Cyril of Alexandria, Glaphyrorum in Leviticam liber (Book of Refinements regarding Leviticus), PG, 69, cols. 353-57.

(27) Theodore Balsamon, Commentarii: Sancti Athanasii Alexandriae epistola ad Amunem monachum (Commentaries: The Letter of Saint Athanasius of Alexandria to Amoun the Monk), PG, vol. 138, col. 552.

(28) Saint Jerome, Ep. 77, Ad Oceanum de morte Fabiolae, in Sancti Hieronymi epistulae (Letter 77: To Oceanus concerning the Death of Fabiola), pars 2 (epp. 71-120), ed. Isidorus Hilberg, Corpus Scriptorum Ecclesiasticorum Latinorum (Corpus of Latin Ecclesiastical Writers), 55 (Vienna and Leipzig: Freytag, 1912), 43-44.

(29) Thomas Sternberg, Orientalium more secutus: Raume und Institutionen der Caritas des 5 bis 7 Jahrhunderts in Gallien (Following the Custom of the Easterners: Places and Institutions of Charity in fifth- and sixth-century Gaul) Jahrbuch fur Antike und Christentum. (Yearbook for Antiquity and Christianity) Erganzungsband (Supplement) 16 (Munster: Aschendorffsche Verlagsbuchhandlung, 1999), 170-71.

(30) Gregory of Tours, Liber in Gloria confessorum, cap. 85, in Monumenta Germaniae Historica, Scriptores Rerum Merovingicarum (Glory of the Confessors, 85 in Historical Monuments of German Writers of Merovingian Events), ed. Bruno Krusch et al. (Hanover: Impensis bibliopoli Hahniani, 1884-85), vol. 1, part 2, 802-03.

(31) Sternburg, Orientalium more secutus, 170-71 et passim; Rothari's Edict in The Lombard Laws. trans. Katherine Fisher Drew (Philadelphia: University of Pennsylvania Press, 1973), p. 83 (cap. 176).

(32) The community regulations for medieval French leprosaria were collected and published by Le Grand, in Statuts d'hotels-Dieu et de leproseries. See Le Grande's introduction to leprosaria, xxv-xxix. (33) Ibid., 181-83.

(34) Ibid., 199; see also Brody, The Disease of the Soul, 101-03.

(35) Le Grand, Statuts d'hotels-Dieu et de leproseries, 199-203

(36) Ibid., 206-14. The bishop of Puy who confirmed these statutes later became Pope Clement IV in 1265.

(37) Edward J. Kealey, Medieval Medicus: A Social History of Anglo-Norman Medicine (Baltimore, MD: Johns Hopkins University Press, 1981), 103-05 (general comments on leprosy), 107-16 (the regulations of Saint Mary Magdalene).

(38) See also Moore, The Formation of a Persecuting Society, 51: "In 1179 the Third Lateran Council reiterated that lepers should be segregated, and were forbidden to go to church or to share churches or cemeteries with the healthy." Compared with Latin text of Canon 23 of the Third Lateran Council, in Sacrorum conciliorum nova et amplissima collection (New and most complete collection of the sacred councils), ed. Giovanni D. Mansi, 53 vols. in 58 parts (Paris-Leipzig: Welter, 1901-29; reprint, Graz: Akademiscke Druk-und Verlagsarstalt, 1960-61), vol. 22, col. 230.

(39) Rothari's Edict, in The Lombard Laws, trans. Katherine Fischer Drew (Philadelphia: University of Pennsylvania Press, 1973), p. 83 (cap. 176).

(40) Capitulare generale (anno 789), in Monumenta Germaniae Historica, Leges (General capitulary (year 789) in Historical Monuments of Germany, The Laws), vol. 1, ed. Georg H. Pertz (Hannover: Impensis bibliopolii aulici Hahniani, 1885), p. 69 (cap. 20).

(41) See the new English translation with introduction by Maria Dobozy, The Saxon Mirror: A Sachsenspiegel of the Fourteenth Century (Philadelphia: University of Pennsylvania Press, 1999). Dobozy states that the Sachsenspiegel was based on old Saxon custom but also contained significant innovations derived from Christian concepts and from new governmental structures of the twelfth and thirteenth centuries.

(42) Ibid., Book 1.4 (p. 70).

(43) Frederick Pollock and Frederic Maitland, The History of English Law Before the Time of Edward 1 (Cambridge: Cambridge University Press, 1952), 1:480.

(44) Balsamon, Commentarii (Commentaries), PG, vol. 138, col. 552.

TIMOTHY S. MILLER is a Professor of History at Salisbury University in Salisbury, Maryland; RACHEL SMITH-SAVAGE received her B.A. in History in 2005 from Salisbury University.
In the High and later Middle Ages, the leper was legally and
   religiously cut off from the rest of society. He was seen as morally
   unclean. Special hospitals served to segregate lepers. Fear of the
   disease, religious impulses, and social attitudes combined to create
   this situation. (13)
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