Gone Medieval - Leprosy in the Middle Ages

Episode Date: November 20, 2023

Leprosy in the Middle AgesMedieval people were very concerned about how to deal with those in their midst who had leprosy, now called Hansen's disease. It's assumed today that sufferers were shunned from society, forced onto the margins, and generally hated.But in this episode of Gone Medieval, Dr. Eleanor Janega finds out from Professor Carole Rawcliffe about what was it really like to live with leprosy, both as a sufferer or as a member of the communities that needed to care for them.This episode was edited by Joseph Knight and produced by Rob Weinberg.Enjoy unlimited access to award-winning original documentaries that are released weekly and AD-FREE podcasts. Get a subscription for £1 per month for 3 months with code MEDIEVAL - sign up here.You can take part in our listener survey here. Hosted on Acast. See acast.com/privacy for more information.

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with a brand-new release every week exploring everything from the ancient world, to World War II. Just visit historyhit.com forward slash subscribe. The figure of the leper looms large in our imaginations about the past. There's good reasons for this. People in the Middle Ages were very concerned with how to deal with individuals in their communities who had this ailment, which we now call Hansen's disease. Moreover, its suffering springs up not only in their midst, but in plenty of biblical tales in saints' lives as well. constant reminders of how difficult it was to survive with it and the care that people needed to have for those suffering from it.

However, often when people do think about those in the Middle Ages who had leprosy, they assumed that they were shunned from society, forced onto the margins and generally hated. So what was it really like to live with this disease, both as a sufferer or as a member of the communities that needed to support them? I'm Dr. Eleanor Yonaga, and today on Gone Medieval from History Hit, I'll be speaking with Professor Carol Ralkleff, a history of the theory and practice of medicine in medieval England and the author of the seminal book, Leprosy in Medieval England, about leprosy, about Leprocy, about Leprosy. It's kind of a charged thing to talk about that leprosy, right? Because I think a big way that people think about, the conception of medieval leprosy isn't actually how medieval people thought about it, right? Like there's a very different way of thinking about leprosy if you're a medieval person. There is, and it's a very complex way, very many different, often contradictory ideas about the disease. I think our ideas about medieval leprosy often come from Victorians because during the 19th century,

there was a major panic about what was called the imperial danger. And this was the threat that people suffering from what we now called Hansen's disease, leprosy, as we know it today, coming west and infecting people. And this seized America as well. There was a lot of panic about people coming from Scandinavia where leprosy was endemic. And for this reason, people became very interested in what had happened in the Middle Ages because it had died out. How did it die out?

Well, obviously, people had been rounded up and segregated. integrated into leper hospitals, just as they were doing in the 19th century. And a lot of the people writing about leprosy were scientists. They weren't particularly interested in the religious aspects of disease, which dominates the Middle Ages, as you know. And they weren't reading the documents. And this is the problem I had actually when I started writing about leprosy, because I got this very clear idea about people ringing bells and going unclean,

you know, and being rounded up into hospitals. And everything I read challenged this. And I began to think, well, hang on, I'm going to have to start in the 19th century, really, and excavate all these ideas. Like, for example, the leper mass. Did people really go through this fake burial ceremony before they went into a leper hospital? Of course they didn't. That's a Victorian elaboration of a 16th century invention. Right. The number of times I have to explain to people that, you know, Iron Maidens aren't real. You know, Victorians were just having a really great time inventing things that they thought would be horrible. But can you tell us a little bit about this myth of the leper mouse? Yes, well, some historians have swallowed it and believe it. And many anthropologists when writing about leprosy, they like that idea. And in fact, in the 16th century, possibly at a loose end, a cleric who was doing the back bits in a service book, invented.

this mass, which was to be celebrated when people went into a Leppah Hospital, and it was a Requiem Mass. People were going through a sort of death ceremony. They were dead to the world. And this was taken up as being something medieval. Now, there may occasionally in 15th century France have been these rituals, but very rarely. And where people got confused is if you go into a leper hospital that is run by a monastic order, like a monk, you're dead. to the world. Right, of course. Because monks are dead. They don't own property. And I think this is where it took off. But of course, if you go into a hospital that's run by the city or by a secular clergy, you're not dead to the world. You may be quite poor, but you're not dead to the world.

So from the very beginnings, there's been a lot of confusion about how medieval people responded to people with leprosy. When we're talking about people with leprosy and the response to them, how endemic is leprosy? Because it is certainly something that you see come up in documents all the time. People are often talking about charitable donations to leper, hospital, or something like this. But how prevalent would we say that it actually was? Well, leprosy is prevalent today. It ceased to be a fashionable disease.

And I hope one thing this website will do will be alert people to the fact that it's still a major medical problem in many parts of the world. Today, it's known as Hansen's disease. because of the awful stigma that attached to the words leprosy and lepros, largely because of 19th century bacteriologists and the life. In the Middle Ages, you have to be very, very careful about this because many of the people in medieval leprosy hospitals did have Hanson's disease, which can be detected sometimes, not always, in the skeleton. But certainly in the earlier middle ages. They may have had all kinds of other diseases because diagnosis was so actually hit and miss until about the 12th, 13th century when the criteria begin to tighten up. And there's a

whole mass of different words that are used to describe the disease. So you can't necessarily assume that because somebody has a disease that's spread by mycobacterium lepride and leads to a very complex massive symptoms that they're going necessary to be in a leper hospital, or that they've been accurately diagnosed in the Middle Ages. So you're looking at a lot of diagnostic confusion as well. You have to be very careful about this. Certain diseases that we associate with the Middle Ages, so, for example, we're very good at that now.

If you've got your selling your pestis, you know, that's just, oh, here's some antibiotics, and you'll be fine. Yes. But leprosy still remains quite difficult for us to treat. It does. It can be rescued through administration. of antibiotics, but it's still a very serious disease. And if it goes untreated, then, you know, if it's in an extreme form, you will die of it in a very unpleasant way, leads to disfigurement,

loss of nervous sensation and the like. Although it can also actually be quite mild. It's a very protean disease. It takes many, many forms. And as communities build up that awful phrase, herd immunity, then you may have it subsisting at a few. fairly moderate level where it's not taking an extreme form. And this is another problem with telling how many people in the middle ages may have had leprosy, because they're not wearing t-shirts and shorts. And it's usually identified initially by the face. And a lot of people, it won't affect the face until it's really, really developed. And it can take a long time to develop, too, up to 20 years. So, you know, you're talking about long incubation periods as well.

So we're looking at something's very complex and you can't necessarily be anachronistic and translate the ideas about modern leprosy back into the Middle Ages. We have to think very carefully about how people understood it then rather than using a modern biomedical form of identification. So if one is sort of identified at the time as having leprosy, are there treatments available for that or is it just sort of a kind of a kind of? kind of like, well, good lot. We'll try to make you comfortable. Oh, yes. There's a massive treatments available. Well, in a long period here, you know, you're going from in England. The first leprosy hospitals come in with the conquest, although we know that there are communities of people with leprosy in England well before that.

It doesn't come in with the Crusades, as Victorians believed. But you have as much Arab literature comes into the West during the 12th and 13th centuries, particularly you have masses of suggestions for cures, ointments, bar, phlebotomy, which is bloodletting, plasters, all kinds of treatments, because people were very anxious if they got the symptoms that they shouldn't develop. Diet is very important because we're looking at a society which explains disease in terms of humoral theory often. And what you eat is very, very important.

You've got to steer off heavy foods, foods that are maybe past their cell-by-date if they're contaminated. fish, milk, there are these ideas that certain foodstuffs can exacerbate your suffering. It says a whole raft of treatments. And if you can afford them, you can spend a fortune, as we know, because some people sue their medics because they're not getting better. Oh. And I suppose that this also really challenges our kind of Victorian idea of the, oh, yes, and well, you're dead to the world and you simply left society. Well, these people clearly have recourse to the legal ideas, you know, and they can.

say, oh, well, I'm suing you. You didn't do a very job here. You know, these aren't people who are completely disempowered or driven from society. No, no, no, they're certainly not driven society. We have this idea of leprosaria, as they're course, these leper hospitals being mild from anywhere in remote places. But in fact, most English leper hospitals are right on the outsides of towns. The ruling in the Bible is that someone with what was then deemed to be leprosy, and its whole raft of skin diseases should be outside the camp. And this was because it was polluting, not because it was contagious. So, it doesn't really matter if you put your leprosy hospital right outside the gates as long as it's

outside the walls. Right. And so these places are put where people have access to running water, plenty of land, transport, road systems so that they can beg as well. So if you went into a medieval town or city, you would see people on your way in who might be begging for arms who had leprosy and you'd also pass a leper hospital. You might pop in to give thanks for a successful journey. but these people aren't isolated.

They're not shut away miles to him anywhere. So let's talk a bit about these myths, you know, because I think what your work has done a really great job of showing is there was this idea of that, oh, yes, we put the leper hospitals outside of towns because everyone hated lepers and they were frightened of them and they were all worried that they were going to get leprosy.

So you put it outside of town. But I think one of the things that your work's been really good at showing is actually one of the reasons you put leper hospitals outside of town is if you're a fancy person who endowed a leper hospital, hospital. Like, hey, everyone, did you see my leper hospital? So everyone who comes into town has to go past it and they'll say, oh, who went down that? Absolutely true. There's a big fashion in the 12th, the 13th century is for finding leper hospitals. It's like, you know, charities today, particular charities are fashionable, aren't they? And then there's a swing into other forms of charitable

giving. There is a very powerful parable in the Bible, which people took great notice of. And this is the story of Dives and Lazarus. And Lazarus is described in the Middle Ages as not just a beggar, but as someone with leprosy. And he bangs on Divey's door. Divey's means rich. And the rich Divey's tells him to go away. So he goes away, dies in a ditch. And the angels carry him to heaven. And he sits in Abraham's bosom, you know, in heaven. And he's next to God. And he has God's ear. But not to the extent that he's able to intercede to pardon Divees, who goes to, to hell. And in the Middle Ages, there are the most amazing depictions in manuscripts and images of divvies in hell and tormented by these horrific demons. And the rich and powerful

are very, very aware of this. And they are well aware, too, that people with leprosy have, if they suffer patiently, have God's ear because they're going straight through purgatory. Right. They're going to go straight to heaven. And in the Middle Ages, even Christ is described as being like a leper. At the time of his crucifixion, quasi leprosus. So you have to be very, very careful how you behave to these people, particularly those who are respectable lepers who are living in their leper hospitals.

So giving to these people is something that is very, very important. not just for the aristocrats and members of the Royal Family and senior ecclesiastics, but also civic corporations. Right, right. It would sort of besmirch your reputation as a good Christian city if, you know, you're not. Absolutely. Lurich, which is where I live, is six or seven hospitals outside. They're small.

These places aren't big, you know, as we imagine, a hospital today. They probably took 12 people or fewer. That's the 12 apostles, of course. And contrary to our ideas, people can go in there to visit their families. And if you don't behave yourself when you're in one, you can get kicked out. So they're not isolation units. Right. So there's just sort of an idea then that you'll have to either fend for yourself or find someone else who will take you. But moving on from there, there's this other myth. So oftentimes when we see people depicted in manuscripts or this sort of thing with leprosy,

one of the things you see is they have their bells or rattles or sort of things that make noise. And the Victorian myth here is that, oh, you would have your bell or you'd have your rattle to let everybody know that you were coming so that they would get out of your way and they would go and run and hide for the people who had leprosy, right? And that is also probably not the case here. It's certainly not the case. There's a famous image which Sir Henry Welcom had painted in 1912, which is called medieval villages scrambling to get away from a leper. And someone who's so desperate, they'd even drop their baby in the street. And this is the antithesis of how medieval people believe. You have a rattle or a bell because you want to attract arms. And often if you have Loprometer's leprosy, your voice is gone. It affects the voice and the throat. So you can't shout.

So you need a bell or a rattle. But people tend to ignore this fact. And of course, if you're going into a town or city, you will see people begging by the street and you will certainly give them arms as you go past. because many leprosy hospitals need the extra money. They have quite modest foundations. Others are quite well off. And those, interestingly, attract private patients.

So, you know, if you've got the sort of a royal endowment or something like that, there might be people who kind of pop in to have their leprosy looked at. Well, you don't give in for a private consultation. You would go in as a patient. Right. And you would go in a larger foundation because it's run like a church. And so you have a round of religious services. And this firstly enables you to pray for your patron, which is very important, a word from our sponsor, you know.

But it also means you can prepare your own soul for death. And of course, in the Middle Ages, people are preoccupied about what's going to happen to their souls after death. Of course, yeah. And if you've got leprosy, this is in some sense, it's paradoxically a bonus. Because if you accept your suffering, this will see you through purgatory extra fast or not at all. You will go straight to heaven. And so in a sense you're one of the elect. But of course, only if you behave in a particular way, you know, you say your prayers and you're what is known possibly as a good leper as opposed to someone who is bad and might join an Alfresco community somewhere outside the walls, which is perhaps less closely regulated.

It's a myth that everybody goes into a hospital. I mean, many people may choose to live in informal communities where they're less regulated. or they don't have to pay. And this is quite interesting because sources that I use, and obviously the sources that I use that come up, it'll be because there's some lecture about sexuality, right? And then that's why the lepers are coming up. I'll see preachers, especially English preachers sort of 14th century,

who are sort of talking about the necessity to go intervene with people who have leprosy and how it's very good for you. You're a very good priest if you go and you preach to the lepers. And they do talk about the sort of good leper, bad leper. where they're saying that, well, there's certain people ended up with leprosy because they were sinful. And it's about this sort of excessive lust for life generally. So lust in a sexual sense, sure, but also they're gluttonous or they're a bit lazy. And so these people are kind of experiencing purgatory now because they were naughty.

And God was saying, now, watch yourself. But they might lean into those impulses. Oh, yes. I mean, one of the explanations for getting leprosy is sexual activity. if you sleep with a woman who's slept with a leper, if you're a man, you're quite likely to contract the disease. And it's also believed that some people contract leprosy because their parents slept while the mother was menstruating. This is seen as another source of infection. And in the Old Testament, of course, leprosy is often depicted as a punishment for pride or envy.

Zaya, the king who celebrates as a priest in the temple, is struck down by God. And so leprosy can be a punishment. And a lot of diseases are seen this way, in a very ambivalent way. In some cases, it's a blessing. In other cases, it's a punishment. And it may depend who you are. And Baldwin the 4th King of Jerusalem has leprosy. And everybody thinks he's a very good thing.

He is defending the faith against the heathen, according to these Christian propagandists. But other people are seen as being struck down because they've done something very bad. I should say that medics, people who are writing about the disease, from a theological standpoint, but from a medical standpoint, tend to be more pragmatic, and they will look at particular aspects of a patient's

behaviour or lifestyle or their family. Do you have leprosy in the family? Oh. They may ask, you know, have you slept with a woman who might be prostitute who might have slept with a leper? Is your diet bad, you know, have you eaten the wrong things? And so they're much less judgmental, but it's interesting to bear in mind that some medical texts on leprosy do advise the physician when giving the verdict to tell the patient that they

have been singled out by God to go through purgagery quickly and that they mustn't be too upset by the diagnosis because it was a crushing diagnosis. It would mean you would have to leave your family, you know, to live outside the walls unless they were very wealthy and they could provide you with, you know, separate accommodation. It is in a world that is expressly very communal. It is a kind of shattering of a particular way of life of an expected kinship bond. Because in a place where you're expecting to live in a kind of a multi-generational household, sort of around your family all the time. Sure, you know, you're just outside the city walls.

It's not that big a deal, but it is something that means that your life's about to change a lot. It does, although you're entering another community. Yeah, true. But there's always exceptions. And one of my favorites is a man called Richard Wallingford, who is abbot of St. Orban's in the early 14th century, and he contracts leprosy. And he's actually depicted in one of the Abbey manuscripts with the spots that we use to denote somebody with a disease. And his monks are told, you know, he's got to go and move into a leprosy hospital.

And they say, no, we love him. We want him to stay with us. We're not getting rid of our abbot. And they actually resist the commissioners who were sent by the ecclesiastical authorities to remove him. And he stays in post until his death. So, you know, there are as exceptions. The first thing you learn when you study this disease is that there are no really hard and fast rules about it. People can differ quite radically in how they respond to the disease, often depending on who the individual is.

Is there also a differentiation that we would see in between, and we've been talking about cities. And partially why we're doing that is because when we live in a city, they're going to be hospitals. So we have archaeological records of this. We know, what do you do if you know you're one of the 80% of people who lives in the countryside? What happens if you know you're a farm girl and you come down with lepros? That's an interesting question. We have much less evidence about this because we do know that local courts and manors, one of the things that they had to report was if any of the villains or any of the rontiers, the people who work on the manor, have leprosy because they should remove themselves. But how far they did this is an interesting question. And it may be that in the countryside, as happened in many places before they were colonised by imperial powers, people would just continue perhaps living with their families. Or there might be little informal communities which would set up outside villages. Sometimes this would have been the case.

It would depend very much on particular local circumstances. There were rural leprosy hospitals too, often on intersections of main roads, so they are accessible. We know rather less about what happened in the country in England than we do what's happening in the towns. And certainly the great majority of the 320-oddlap hospitals founded in England are founded in suburbs, although the definition of suburban varies, obviously, if you're in a big town or city or in a small one. And one of the factors about medieval leprosy hospitals is that people can live a long time with the disease, especially if they have a good diet, they're kept clean, their lesions are bound up. And many of these places have orchards.

They have piggeries. They have small holdings where people can grow plants. And in the regimens that are drawn up for people with the disease, keeping cheerful, if you can with such a terrible disease, is recommended because it helps your human balance. And part of keeping cheerful is having gardens. We know in France, in the work of the historian called Francois Léviot, We know that some labour hospitals, they played bull.

That's lovely. We don't know if they played bowls in England, but we do know that they kept animals. So they're leading a lifestyle, which is in many respects not much different from the one they may have led before. Although, of course, there is this round of religious observance in the larger hospitals, which they are expected to follow. So is it quite astringent as we would expect from, well, I suppose this is a silly one? because I was going to say, is it the same kind of level of expectation that we would see from a monk, but perhaps it is if you're in a monastic institution and less so if it's kind of secular. Yes, they very, very much. Monastic leprosaria, on paper, at least, you know, you have to follow the canonical hours.

You have to go to church regularly to say your prayers. You have to hear mass every day. At least once, you have to pray for the soul of the patron. In the smaller suburban level hospitals, the rules would not be quite so rigid. But, you know, these places have the equivalent of Ofsted inspections. And we know a lot about them from the reports that the equivalent of the inspectors put in, you know, is this very bad? Is it good? Yeah. Usually could improve.

And so we know that in many cases, they're not following the rules so stringently. Right. Okay. And sometimes the brothers may be mixing with the sisters, which is distinctly forbidden. In some cases, the diet may not have been up to standard. You know, the master may have been creaming off some of the profits. The inspectors are also very exercised about letting in private patients who are often not leprous. They simply want nice sheltered accommodation.

And one of the big scandals is St. Charles's Leap Hospital in Holborn, near where Centre Point is now. And here they were tremendous scandals because most of the places had been sublet to people who paid to have sheltered accommodation. Okay. And when there was supposed to be 14 beds for leprous citizens of London, and they weren't there. And the mayor and the corporation are repeatedly suing the masters of the hospital, you know, to have access. So we do know that there are often quite a lot of abuses. So it shows you that people aren't essentially always exercised about being in reasonable proximity to somebody with lepros. I have to say that after the Black Death, which is the first outbreak, is 1348,

to 50. People become more anxious about this because they're afraid that people with leprosy may be spreading bad air because, of course, the wounds, Anto was well cheated and people may seem infectious. And they're afraid that this bad air may contribute to the spread of plague. And we do need to remember that the black death comes back repeatedly over and over again. And so there's a wave of crackdowns where people are becoming a. a bit more anxious about getting anyone with leprosy into a place where they can be properly looked after. So we need to think about changing responses to the disease, particularly after the black death. It's not all the same kind of response. Medical science is changing all the time.

This kind of brings me to the last thing that I wanted to ask you about. So there's this common way of talking about medieval society and people with leprosy are always brought up in this context, which is there's this idea of the persecuting society, this idea that what medieval Europe is like and what Christendom is like is it is constantly seeking to say this is who the ideal individual within our society is. And they are Christian, they're probably a man, they are healthy in these particularized ways.

And so it creates these sort of outside groups. So Jewish people, people with leprosy, women. People like this, you know, where it's a part of society, but that's, you don't want to look at them. And I think one of the big ways that we've always sort of traditionally treated people with leprosies is, oh yeah, you're a problem. And everything that you're saying goes against this. You know, it's like if you're trying to get a spot in the leprosy hospital as a wealthy person, then clearly things aren't quite that cut and dry, are they? No, they're not. I mean, it would be wrong to say there's no persecution of people with leprosy. There is in France, for example, in 1320s, some lepers are even burnt at the stake. There's believed to have been this plot in conjunction, of course, with that. other hate group Jewish people. There isn't anything like this in England, I have to say. But there are, of course, period, notably after the Black Deaths,

when people are worried that individuals with leprosy may spread the miasmas of play. And often, and this is another side to the disease, near do well, people who you don't like in society, can often be said to be lepros just to get rid of them. And I spend a lot of time going through leaked records. These are court records of medieval English towns and cities. And it's quite interesting when you go through these to see that certain individuals who may not fit the profile, as you say, sex workers, foreigners, people who come from Germany,

Flanders, whatever, are often the ones who were accused of being lepros and they're therefore invited to leave. And my favourite story is of a woman called Alice Dimmock, who is a sex worker in Yarmouth. And she is had up for all sorts of offences, soliciting, arguing with her neighbours, you name it running an immoral house. And they cannot get rid of it. And in the end, they decide, right, Alice, you're lepros, you're out. And they do get rid of her for that. She's bound over in five pounds, which is a massive amount of money.

Wow. To leave Yarmouth. And she does go. So there is a side to it. But on the other hand, in the same period, you have people such as Marjorie Kemp, the well-known mystic, just up the coast in Kings Lynn, who goes into the leprosy hospital. in Lynn and kisses the feet of people with leprosy because she sees them as being like Christ.

And as I said when I started, this is a very ambiguous response. It's very contradictory because none of us always agree with ourselves, do we, let alone everybody else. Carol, I think we're going to have to be there, but I can't thank you enough for coming along to talk with me about this. It's a great pleasure. Thank you very much. Cheers. Thanks so much for listening. thanks to Carol for joining me. I'm Dr. Eleanor Yaniga, and this has been Gone Medieval from

History Ahead. And if you like what you've heard, don't forget to rate, review, follow the podcast, and tell your friends about it. My co-host Matt Lewis will be back on Friday with more medieval goodness, and I'll be back next Tuesday. Until next time.