Tuesday, December 27, 2011

The Strange Case of the Medieval Leper (Part II)

The prevalence of leprosy in the warmer environment of the Middle East and the spread of the disease in the early medieval period in Europe lead to the infection of individuals of some note in history.  In 1119, for instance, a crusader commonly known as Robert of Zerdana lead troops against the Muslim troops, despite having leprosy.¹

Map of Near East during the early Crusades

Coin from Antioch, period of the Crusades

In 1174, Baldwin IV – who was visibly leprous – was crowned Latinate king of Jerusalem.  Baldwin’s tutor, William of Tyre, was the first to notice that the young man had one of the signs leprosy: the inability to feel pain in the appendages.  When Baldwin took the throne, Pope Alexander III denounced the coronation, associating leprosy with sin and insisting that the acceptance of Baldwin as king would be the downfall of the Christian kingdom in the East.²  There are several illuminations of Baldwin in the early medieval period, and he is depicted with the lesions characteristic of the disease. 

Baldwin IV (top) on his deathbed.

In the 1995 film Braveheart, Scottish lord Robert Bruce is represented as having leprosy.  While there is no historical evidence to buttress this portrayal, there is historical documentation suggesting that his son, who would become Robert Bruce I (coronated 1306), did have the disease. A contemporary chronicle insisted he could not engage in a 1327 battle due to the debilitating effects of leprosy, but modern scholars suggest Robert may have had a form of syphilis.  This debate is interesting, but since medieval Scotsmen believed Robert had leprosy, they would have treated him as if he had the disease.

Robert Bruce's death mask

Pope Alexander’s association of leprosy with sin would travel along with the disease as it affected Europeans on the continent.  Since it was difficult to distinguish between the effects of syphilis and leprosy, lepers were often characterized as possessing an “inordinate sexual appetite …incestuous… rapists… [who] sought to spread their condition by forced sexual intercourse with healthy persons.”³ Persons catching the disease were also thought to be bearing the burden of a curse that could go back generations, with the son paying for the sins of the father.  The disease was considered just cause for divorce, and prior to being cast out from society to live in the margins, the leper was often bestowed with the last rites of the dead – despite the possibility that he or she might live many years. 

Two lepers' windows in medieval
                English churches. Allegedly, these
windows gave lepers access to mass from
the exterior of the churches.


Libera me, Domine: Medieval chant that a priest or already sick man might perform for the leper before he is cast out of society. 
Already marked by the lesions, loss of appendages, and clappers or bells that announced their movements, the lazar in Europe was marginalized in terms of space, too.  Lepers were to live outside of city walls, eking out a living, if they were not fortunate enough to live near a leprosarium.  

Map of London, with its many gates (top)
London Roman gate (buttom)
Such devices prevented outsiders and l
epers access to the city

In medieval literature and even in medieval etymology, leprosy is associated with ostracism and moral decrepitude.  In one version of Tristan and Isolde¸ Isolde is sentenced to serve as a whore for colony of lepers.  Tristan disguises himself as a lazar so that he can be with Isolde, but the text is ambiguous about his intent – implying that Isolde’s association with the leprous also has her steeped in sin.  The Oxford English Dictionary, which tracks etymological lineages, lists terms such as the “leprosy of villainy,” “leprosy of the soul,” and the “leprosy of sin” as common usages of the period.4 

For some men of the cloth, ministering to the lazars was considered the highest act of Christian charity.  Alberic, of the Order of Saint Lazarus in Jerusalem, aided the lepers, coming into daily contact with them.  According to legend, Alberic would wash their feet and althoughthe water mixed with the blood and discharge moved him to nausea, but he at once immersed his face and, horrible to say, took away not the least part.” 5

Burton stone carving of a leper (top)
and Burton lazar seal (bottom) both from England

Medieval European monarchs typically tried to leave the “leper problem” under the jurisdiction of the church and its many lazar houses, but in one very disturbing instance in fourteenth-century France, the lepers were persecuted under the jurisdiction of Philip V.  To understand the events of the persecution, a brief discussion of the 1320 Pastoreaux, or Shepherd’s Crusade, is crucial.  In 1320 in Normandy, a teenaged shepherd claimed to have a vision instructing him to lead a campaign against the Moors in Spain.  As the movement gained momentum, the goal of the crusaders became mired in anti-Semitism and well as anti-Islamism. Finding no Moors to attack in their campaign across France, the Pastoreaux turned their vitriol toward the Jewish communities.  After the crusade disbanded, Philip fined the communities that did not protect the Jews during the upheaval. 

Philip V of France

Bereft of an acceptable target – since Philip was protecting the Jews by levying these fines – the thwarted crusaders soon found another mark for their hatred.  During Easter of 1321, the mayor of Perigueux arrested all the lepers under his jurisdiction after hearing rumors that the lazars were stashing barrels of rotting bread with which they intended to poison local wells.  The lepers were systematically tortured.  Few confessions survive, but there is one from a Johan de Bosco who admitted that he was part of a leper conspiracy to poison wells, fountains, rivers of “diverse areas.”6 

Medieval illumination of Jews being burned
at the stake.  Note the circular yellow badges.

Johan claimed he was paid to spread poison through various cities and villages in France.  As rumors of the leprous infecting wells spread through the countryside, accusations ran rampant.  Rumors held that the lepers were under the direction and purse of the Jews – who had hoped to deflect attention from themselves. The Jews, in turn, had been hired to poison all Christians by the Muslim king of Granada. 

Unlike the Jews, who saw some royal protection, the lepers were a ready target for medieval persecution.  Their bodies already had them marked as sinful, diseased, and rotting.  The leper houses were “privileged, endowed institutions,” with eight houses in France and significant land holdings.7  In this case, Philip does not authorize an organized campaign against the lepers – but his June 1321 proclamation that the accused lazars face torture and burning for their crimes might as well have been an official stamp of approval.  The deaths of the convicted lepers in France meant that their significant holdings would go to the king’s coffers. 

Swineburne's "The Leper"
continued to perpetuate stereotypes
about people suffering from Hansen's disease

Leprosy saw a decline in the later Middle Ages, perhaps in part because the Crusades ended, but also because the communities in which they lived insisted on their separation from society.  Although the numbers of leprous skeletons in medieval cemeteries waned, and archeological digs from the period have demonstrated the decline, interest in this figure living on the fringes of society continued well into the Victorian age, with poets such as Lord Alfred Tennyson and Algernon Charles Swineburne writing pieces on the lazar.   500 years had passed since the leper persecutions of 1320s France, yet Swineburne’s poem – which you can read in its entirety at the link below – maintained the disdain and suspicion of leper’s sexuality in its figure of the lecherous churchman who is obsessed with his leprous female charge as she suffers the effects of the disease and after she dies. 


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1.        See Malcolm Barber,  “The Order of Saint Lazarus and the Crusades,”  The Catholic Historical Review, Vol. 80, No. 3 (Jul., 1994): 439-456.

2.        Ibid, 441.

3.        See Douglas, 732.

4.        See Barber, 455.

5.        Ibid, 446.

6.        See David Nirenberg, Communities of Violence: Persecution of Minorities in the Middle Ages, (Princeton: Princeton UP, 1996): 56. 

7.        Ibid, 56.

Thursday, December 22, 2011

The Strange Case against the Medieval Leper (Part I)

Tracking the instances and development of medieval leprosy present an enormous challenge to the modern researcher.  While there are no shortages of texts or images from the period, medieval physicians had a limited understanding of the pathology of leprosy.  Modern forensics has proved to be an essential tool in unraveling the mystery of the medieval leper.  In this two-part series, medieval-csi hopes to shed light on leprosy in the early and later Middle Ages, including the encounters with the disease during the Crusades, the marginalization of European lepers during the fourteenth-century, and the municipally-propagated murders of lepers sanctioned by the French king Philip V. 

Cosimo Rosella's The Healing of the Lepers

Leprosy, or Hansen’s disease, was known as the affliction of the lazar in the Middle Ages, from the biblical Lazarus raised by Christ in the Gospel of John.  Although the gospel does not specify the disease that killed Lazarus, the later association of leprosy with Lazarus appears to be an amalgamation of Christ’s miracle of raising Lazarus from the dead and the healing of lepers in the gospels of Luke and Mark. 

1906 photograph of Lazarus's tomb, West Bank

Medieval physicians did attempt to define the disease, and the results met varying degrees of success.  Lilium medecin√¶, written by Bernhard Gordon about 1305 or 1309, describes several stages of the disease, including the loss of hair (including eyelashes and eyebrows), lesions and “pustules,” and loss of extremities.

Early modern depiction of leprosy treatment

Gordon also insisted that lepers should be confined to a leprosarium or Lazar House to contain the disease.  Most importantly, he insisted on concrete diagnosis of the disease, the signa infallibilia – the irrefutable signs of leprosy.[1]  

18th-century Chinese depiction of leprosy

Despite some ideas about what constituted leprosy, European medieval men and women did not have an infallible method for diagnosing the disease and, in fact, often mistook the external decay of the flesh for a sign of moral decrepitude.  Arabic medical authorities were one of the few communities who understood that leprosy was transmitted from person to person via contagion, not spiritual failings, although treatment for the disease in all areas was limited to cauterization of the lesions and more bizarre treatments such as bathing in the blood of virgins, babies, or lambs.   

Arabic cauterization of lepers' boils

Modern studies of Hansen’s disease have discovered that there are two strains of leprosy, lepromatus leprosy and tuberculoid leprosy, the latter of which is the more infectious of the two.[2]  Leprosy spreads through respiratory droplets and it seems to thrive in milder climates where sufferers live in poor conditions.  Skin lesions are the primary indicator of the disease, but the progressive loss of appendages – generally the nose and digits – are not due to the leprosy itself, but from infection that attacks these body parts.  The disease can also attack the eyes, leaving the victim blind. 

19th-centurer sufferer of Hansen's disease, or leprosy

Part of the problem with diagnosing leprosy – a problem that likely colored perception of the illness – was that syphilis, a sexually transmitted disease, tended to mimic the indicators of leprosy.  Additionally, as one historian finds, other skin diseases and ulcers of the skin were often lumped with leprosy, despite Gordon’s insistence on the signa infallibilia.

Johnny Depp as the Earl of Rochester in The Libertine. 
Rochester suffered from syphilis, a disease that mimics
                              the effects of leprosy

Modern archeology and forensics can credibly identify the disease in skeletal remains (see picture), which helps to identify the number of patients in medieval churchyards who could have had the disease.  In one medieval leprosarium churchyard, only 24% of the dead had signs of leprosy, which may indicate that the disease was over diagnosed.[3]

Skeleton with telltale signs of leprosy

Lepers were highly regulated in medieval society, even in the Anglo-Norman period of British history, shortly after William the Conqueror invaded England.  Required to live in leprosariums or outside of city walls, lepers were on the fringes of medieval society, which meant that their status was tenuous.  In most medieval cities, they were also required to use bells or clappers to announce their approaches, so that other citizens could avoid them.

Medieval leper clapper, used to warn other people that
                               a leper was approaching.

Archeological digs have discovered an Anglo-Saxo leper hospital in Winchester (link available below), but the legislation and history of medieval England rarely mention lepers prior to the invasion, when the first Norman archbishop of Canterbury founded a leprosarium in the late 11th century.[4] 

St. Mary Magdalene leprosarium's medieval seal

Henry II (1133-1189) allegedly dealt with the leper problem in England by having the diseased burned at the stake without allowing them last rites – a strong indication that he believed their condition to be the result of an unforgivable sin. His grandson, Edward I (1239-1307), allowed the lepers these rites but also had them burned at the stake. 
Most of the later medieval kings – perhaps fueled by the allegations that Henry IV (1366-1413) suffered from Hansen’s disease – dealt with the lepers more gently, allowing for and even aiding the establishment of what would become nearly 19,000 leper hospitals across the medieval continent.  Many of these hospitals, such as the Dunwich leprosarium pictured below, were founded outside of city walls.

Ruins of Dunwich leper hospital. 
The last leper was buried in 1536,
  but the building was still in use until
                                               the mid-17th century.
Intriguingly, the history of leprosy shifts again to the Middle East, to its biblical source, in the late eleventh-century Crusades promoted by Pope Urban II in 1095.  Once Europeans ventured to the warmer climes, they were exposed to the disease more often than they were in the colder climates of Europe.  By the twelfth century, leprosy was rampant enough among the Crusaders that an edict known as the Livre du Roi mandated leprous knights joined the newly established Order of Lazarus.[5]

The Saint Lazarus cross

Like the more well-known Knights Templar, the Knights of the Order of Saint Lazarus – despite their diseased status – were a fighting order.  They engaged in numerous battles during the Crusades, with an entire force of the lazar-knights being decimated in 1244.  The continued squabbles over the Holy Land and the exposure to leprosy ensured that the order of Saint Lazarus would remain a force in the Holy Lands. 

Next time, Part II: Leper-kings and the alleged poison conspiracy of French lepers.

Medieval-csi values your input.  Weigh in below in the comments.

[1] For Gordon’s full description of leprosy, see Charles Hope’s The Leper in England: With Some Account of the Lazar Houses in England, http://www.gutenberg.org/files/29737/29737-h/29737-h.htm
[2] See Frances Lee and John Maighton, 279. 

[3][3] See Peter Richard’s The Medieval Leper.  (Brewer, 2000).  Though Brewer present the evidence of the archeological dig, he does not, as I do here, suggest the possibility that leprosy was diagnosed in cases where it did not actually manifest.

[4] See http://www.britarch.ac.uk/ba/ba117/feat2.shtml for details of the Anglo-Saxon dig. 
[5] See Malcolm Barber’s Malcolm Barber.  “The Order of Saint Lazarus and the Crusades.”  The Catholic Historical Review, Vol. 80, No. 3 (Jul., 1994), pp. 439-456 for information on the Saint Lazarus order during the Crusades.