LEPROSY IN MEDIEVAL BRITAIN.
The history of leprosy in Britain can hardly be the history of leprosy
alone, but of that disease along with others which were either mistaken
for it or conveniently and euphemistically included under it. That there
was leprosy in the country is undoubted; but it is just as certain that
there was _lues venerea_; that the latter as a primary lesion led an
anonymous existence or was called _lepra_ or _morphaea_ if it were called
anything; that the remote effects of the lues were not known as such,
being taken for detached or original outcomes of the disordered humours
and therefore in the same general class as leprous manifestations; and
that the popular and clerical notions of leprosy were too superstitious
and inexact, even if the diagnostic intention had been more resolute than
it was, to permit of any clear separation of the leprous from the
syphilitic, to say nothing of their separation from the poor victims of
lupus and cancer of the face, of scrofulous running sores, or of neglected
skin-eruptions more repulsive to the eye than serious in their nature. I
shall give some proof of each of those assertions--as an essential
preliminary to any correct handling of the historical records of British
leprosy.
Leprosy in Medieval Medical Treatises.
The picture given of true leprosy in the medieval treatises on medicine is
unmistakeable. There are two systematic writers about the year 1300 who
have left a better account of it than the Arabian authors from whom they
mostly copied. While the writers in question have transferred whole
chapters unaltered from Avicenna, Rhazes and Theodoric, they have improved
upon their models in the stock chapter ‘De Lepra.’ It so happens that
those two writers, Bernard Gordonio and Gilbertus Anglicus, bear names
which have been taken to indicate British nationality, and the picture of
leprosy by the latter has actually been adduced as a contemporary account
of the disease observed in England[134]. Gordonio was a professor at
Montpellier, and his experience and scholarship are purely foreign. The
circumstances of Gilbert the Englishman are not so well known; but it is
tolerably certain that he was not, as often assumed, the Gilbert Langley,
Gilbert de l’Aigle, or Gilbertus de Aquila, who was physician to Hubert,
archbishop of Canterbury († 13 July, 1205)[135], having been a pupil at
Salerno in the time of Aegidius of Corbeil (about 1180). The treatise of
Gilbertus Anglicus bears internal evidence of a later century and school;
it is distinguished by method and comprehensiveness, and is almost exactly
on the lines of the _Lilium Medicinae_ by Gordonio, whose date at
Montpellier is known with some exactness to have been from 1285 to about
1307. Future research may perhaps discover where Gilbert taught or was
taught; meanwhile we may safely assume that his scholarship and system
were of a foreign colour. The medical writer of that time in England was
John of Gaddesden, mentioned in the end of the foregoing chapter; he is
the merest plagiary, and the one or two original remarks in his chapter
‘De Lepra’ would almost justify the epithet of “fatuous” which Guy de
Chauliac applied to him.
Although we cannot appeal to Gilbertus Anglicus for native English
experience any more than we can to his _alter ego_, Gordonio, yet we may
assume that the picture of leprosy which they give might have been
sketched in England as well as in Italy or in Provence. The conditions
were practically uniform throughout Christendom; the true leprosy of any
one part of medieval Europe is the true leprosy of the whole.
Gilbert’s picture[136], as we have said, is unmistakeable, and the same
might be said of Bernard’s[137]--the eyebrows falling bare and getting
knotted with uneven tuberosities, the nose and other features becoming
thick, coarse and lumpy, the face losing its mobility or play of
expression, the raucous voice, the loss of sensibility in the hands, and
the ultimate break-up or _naufragium_ of the leprous growths into foul
running sores. The enumeration of nervous symptoms, which are now
recognised to be fundamental in the pathology of leprosy, shows that
Gilbert went below the surface. Among the “signa leprae generalia” he
mentions such forms of hyperaesthesia as _formicatio_ (the creeping of
ants), and the feeling of “needles and pins;” and, in the way of
anaesthesia, he speaks of the loss of sensibility from the little finger
to the elbow, as well as in the exposed parts where the blanched spots or
thickenings come--the forehead, cheeks, eyebrows, to which he adds the
tongue. Gilbert’s whole chapter ‘De Lepra’ is an obvious improvement upon
the corresponding one in Avicenna, who says that _lepra_ is a cancer of
the whole body, cancer being the _lepra_ of a single member, and is
probably confusing lupus with leprosy when he describes the cartilages of
the nose as corroded in the latter, and the nostrils destroyed by the same
kind of _naufragium_ as the fingers and toes. All students of the history
or clinical characters of leprosy, from Guy de Chauliac, who wrote about
1350, down to Hensler and Sprengel, have recognised in Gilbert’s and
Bernard’s account of it the marks of first-hand observation; so that we
may take it, without farther debate, that leprosy, as correctly diagnosed,
was a disease of Europe and of Britain in the Middle Ages.
Having got so far, we come next to a region of almost inextricable
confusion, a region of secrecy and mystification, as well as of real
contemporary ignorance. We may best approach it by one or two passages
from Gilbert and Gordonio themselves. The systematic handling of _lepra_
in their writings is one thing, and their more concrete remarks on its
conditions of origin, its occasions, or circumstances are another. What
are we to make of this kind of leprosy?--“In hoc genere, causa est
accessus ad mulierem ad quam accessit prius leprosus; et corrumpit
velocius vir sanus quam mulier a leproso.... Et penetrant [venena] in
nervos calidos et arterias et venas viriles, et inficiunt spiritus et
bubones, et hoc velocius si mulier,” etc. Or to quote Gilbert again: “Ex
accessu ad mulieres, diximus superius, lepram in plerisque generari post
coitûs leprosos[138].” Or in Gordonio: “Et provenit [lepra] etiam ex nimia
confibulatione cum leprosis, et ex coitu cum leprosa, et qui jacuit cum
muliere cum qua jacuit leprosus[139].” That these circumstances of
contracting _lepra_ were not mere verbal theorizings inspired by the
pathology of the day and capable of being now set aside, is obvious from a
_historia_ or case which Gordonio introduces into his text. “I shall tell
what happened,” he says; and then proceeds to the following relation:[140]
“Quaedam comtissa venit leprosa ad Montem Pessulanum [Montpellier], et
erat in fine in cura mea; et quidam Baccalarius in medicina ministrabat
ei, et jacuit cum ea, et impregnavit eam, et perfectissime leprosus factus
est.” Happy is he therefore, he adds, who learns caution from the risks of
others.
Here we have sufficient evidence, from the beginning of the fourteenth
century, of a disease being called _lepra_ which does not conform to the
conditions of leprosy as we now understand them. The same confusion
between leprosy and the _lues venerea_ prevailed through the whole
medieval period. Thus, in the single known instance of a severe edict
against lepers in England, the order of Edward III. to the mayor and
sheriffs of London in 1346[141], the reasons for driving lepers out of the
City are given,--among others, because they communicate their disease “by
carnal intercourse with women in stews and other secret places,” and by
their polluted breath. It was pointed out long ago by Beckett in his
paper on the antiquity of the _lues venerea_[142], that the polluted
breath was characteristic of the latter, but not of leprosy. Of course the
pollution of their breath might have meant no more than the theoretical
reasoning of the books (as in Gilbert, where the breath of lepers, as well
as the mere sight of them, is said to give the disease, p. 337), but the
breath was probably obnoxious in a more real way, just as we know, from
Gordonio’s case at Montpellier, that the other alleged source of “leprous”
contagion was no mere theoretical deduction. As the medieval period came
to an end the leper-houses (in France) were found to contain a
miscellaneous gathering of cases generically called leprous; and about the
same time, the year 1488, an edict of the same purport as Edward III.’s
London one of 1346, was issued by the provost of Paris against _les
lépreux_ of that city. The year 1488 is so near the epidemic outburst of
the _morbus Gallicus_ during the French campaigns on Italian soil in
1494-95, that the historian has not hesitated to set down that sudden
reappearance of leprous contagion, in a proclamation of the State, to a
real prevalence already in Paris of the contagious malady which was to be
heard of to the farthest corners of Europe a few years after[143].
There is no difficulty in producing evidence from medieval English records
of the prevalence of _lues venerea_, which was not concealed under the
euphemistic or mistaken diagnosis of leprosy. Instances of a very bad
kind, authenticated with the names of the individuals, are given in
Gascoigne’s _Liber Veritatum_, under the date of 1433[144].
In the medieval text-books of Avicenna, Gilbert and others, there are
invariably paragraphs on _pustulae et apostemata virgae_. In the only
original English medical work of those times, by John Ardern, who was
practising at Newark from 1349 to 1370, and came afterwards to London,
appearances are described which can mean nothing else than
condylomata[145]. From a manuscript prescription-book of the medieval
period, in the British Museum, I have collected some receipts (or their
headings) which relate, as an index of later date prefixed to the MS.
says, to “the pox of old[146].”
Some have refused to see in such cases any real correspondence with the
modern forms of syphilis because only local effects are described and no
constitutional consequences traced. But no one in those times thought of a
primary focus of infection with its remoter effects at large, in the case
of any disease whatsoever. Even in the great epidemic of syphilis at the
end of the fifteenth century, the sequence of primary and secondary
(tertiaries were unheard of until long after), was not at first
understood; the eruption of the skin, which was compared to a bad kind of
variola, the imposthumes of the head and of the bones elsewhere, together
with all other constitutional or general symptoms, were traced, in good
faith, to a disordered liver, an organ which was chosen on theoretical
grounds as the _minera morbi_ or laboratory of the disease[147]. The
circumstances of the great epidemic were, of course, special, but they
were not altogether new. No medieval miracle could have been more of a
suspension of the order of nature than that _luxuria_, _immunditia_, and
_foeditas_, with their attendant _corruptio membrorum_, should have been
free from those consequences, in the individual and in the community,
which are more familiar in our own not less clean-living days merely
because the sequence of events is better understood. That such vices
abounded in the medieval world we have sufficient evidence. They were
notorious among the Norman conquerors of England, especially notorious in
the reign of William Rufus[148]; hence, perhaps, the significance of the
phrase _lepra Normannorum_. That particular vice which amounts to a felony
was the subject of the sixth charge (unproved) in the indictment of the
order of the Templars before the Pope Clement V. in 1307. Effects on the
public health traceable to such causes, for the most part _sub rosa_, have
been often felt in the history of nations, from the Biblical episode of
Baal-peor down to modern times. The evidence is written at large in the
works of Astruc, Hensler and Rosenbaum. We are here concerned with a much
smaller matter, namely, any evidence from England which may throw light
upon the classes of cases that were called leprous if they were called by
a name at all.
Under the year 1258, Matthew Paris introduces a singular paragraph, which
is headed, “The Bishop of Hereford smitten with polypus.” The bishop, a
Provençal, had made himself obnoxious by his treacherous conduct as the
agent of Henry III. at the Holy See in the matter of the English subsidies
to the pope. Accordingly it was by the justice of God that he was deformed
by a most disgraceful disease, to wit, _morphea_, or again, “morphea
polipo, vel quadam specie leprae[149].” According to the medical teaching
of the time, as we find it in Gilbertus Anglicus, _morphaea_ was an
infection producing a change in the natural colour of the skin; it was
confined to the skin, whereas _lepra_ was in the flesh also; the former
was curable, the latter incurable; _morphaea_ might be white, red, or
black[150]. The account of _morphaea_ by Gordonio is somewhat fuller. All
things, he says, that are causes of _lepra_ are causes of _morphaea_; so
that what is in the flesh _lepra_ is _morphaea_ in the skin. It was a
patchy discoloration of the skin, reddish, yellowish, whitish, dusky, or
black, producing _terribilis aspectus_; curable if recent, incurable if of
long standing; curable also if of moderate extent, but difficult to cure
if of great extent[151]. In this description by Gordonio a modern French
writer on leprosy[152] discovers the classical characters of the syphilis
of our own day: “not one sign is wanting.”
No doubt the medical writers drew a distinction between _morphaea_ and
_lepra_, as we have seen in quoting Gilbert and Gordonio. Gaddesden, also,
who mostly copies them, interpolates here an original remark. No one
should be adjudged leprous, he says, and separated from his fellows,
merely because the “figure and form” (the stock phrase) of the face are
corrupted: the disease might be “scabies foeda,” or if in the feet, it
might be “cancer.” Nodosities or tubercles should not be taken to mean
leprosy, unless they are confirmed (inveterate) in the face[153]. But how
uncertain are these diagnostic indications, as between _lepra_ and
_morphaea_, _lepra_ and “scabies foeda,” _lepra_ and “cancer in pedibus!”
If there were any object in calling the disease by one name rather than
another, it is clear that the same disease might be called by a euphemism
in one case and by a term meant to be opprobrious in another. Although
leprosy was not in general a disease that anyone might wish to be credited
with, yet there were circumstances when the diagnosis of leprosy had its
advantages. It was of use to a beggar or tramp to be called a leper: he
would excite more pity, he might get admission to a hospital, and he might
solicit alms, under royal privilege, although begging in ordinary was
punishable. It is conceivable also that the diagnosis of leprosy was a
convenient one for men in conspicuous positions in Church and State. It is
most improbable that the “lepra Normannorum” was all leprosy; it is absurd
to suppose that leprosy became common in Europe because returning
Crusaders introduced it from the East, as if leprosy could be “introduced”
in any such way; and it is not easy to arrive at certitude, that all the
cases of leprosy in princes and other high-placed personages (Baldwin IV.
of Jerusalem who died at the age of twenty-five,[154] Robert the Bruce of
Scotland,[155] and Henry IV. of England[156]) were cases that would now be
diagnosed leprous.
Instances may be quoted to show that the name of leper was flung about
somewhat at random. Thus, in an edict issued by Henry II., during the
absence of Becket abroad for the settlement of his quarrel with the king,
it was decreed that anyone who brought into the country documents relating
to the threatened papal interdict should have his feet cut off if he were
a regular cleric, his eyes put out if a secular clerk, should be hanged if
a layman, and be burned if a _leprosus_--that is to say, a beggar or
common tramp. Again, in the charges brought for Henry III. against the
powerful minister Hubert de Burg in 1239, one item is that he had
prevented the marriage of our lord the king with a certain noble lady by
representing to the latter and to her guardian that the king was “a
squinter, and a fool, and a good-for-nothing, and that he had a kind of
leprosy, and was a deceiver, and a perjurer, and more of a craven than any
woman[157]” etc.
There is also a curious instance of the term leprous being applied to the
Scots, evidently in the sense in which William of Malmesbury, and many
more after him, twitted that nation with their cutaneous infirmities. When
the Black Death of 1348-9 had reached the northern counties of England,
the Scots took advantage of their prostrate state to gather in the forest
of Selkirk for an invasion, exulting in the “foul death of England.”
Knighton says that the plague reached them there, that five thousand of
them died, and that their rout was completed by the English falling upon
them[158]. But the other contemporary chronicler of the Black Death,
Geoffrey le Baker[159], tells the story with a curious difference. The
Scots, he says, swearing by the foul death of the English, passed from the
extreme of exultation to that of grief; the sword of God’s wrath was
lifted from the English and fell in its fury upon the Scots, “et [Scotos]
per lepram, nec minus quam Anglicos per apostemata et pustulos, mactavit.”
The _apostemata_ and _pustuli_ were indeed the buboes, boils and
carbuncles of the plague, correctly named; but what was the _lepra_ of the
Scots? It was probably a vague term of abuse; but, if the clerk of Osney
attached any meaning to it, it is clear that he saw nothing improbable in
a disease called _lepra_ springing up suddenly and spreading among a body
of men.
We conclude, then, that _lepra_ was a term used in a generic sense because
of a real uncertainty of diagnosis, or because there was some advantage to
be got from being called _leprosus_, or because it was flung about at
random. But there is still another reason for the inexact use of the terms
_lepra_ and _leprosus_ in the medieval period, namely, the dominant
influence of religious tradition. The heritage or accretion of religious
sentiment not only perverted the correct use of the name, but led to
regulations and proscriptions which were out of place even for the real
disease.
The Biblical Associations of Leprosy.
Among the synonyms for _leprosi_ we find the terms “pauperes Christi,
videlicet Lazares,” the name of “Christ’s poor” being given to lepers by
Aelred in the twelfth century and by Matthew Paris in the thirteenth. The
association of ideas with Lazarus is a good sample of the want of
discrimination in all that pertains to medieval leprosy. The Lazarus of St
Luke’s Gospel, who was laid at the rich man’s gate full of sores, is a
representative person, existing only in parable. On the other hand, the
Lazarus of St John’s Gospel, Lazarus of Bethany, the brother of Martha and
Mary, the man of many friends, is both a historical personage and a saint
in the calendar. But there is nothing to show that he was a leper. He had
a remarkable experience of restoration to the light of day, and it was
probably on account of an episode in his life that made so much talk that
he received posthumously the name of Lazarus, or “helped of God[160].” The
name of the man in the parable is also generic, just as generic as that
of his contrast Dives is; but specifically there was nothing in common
between the one Lazarus and the other. Yet St Lazarus specially named as
the brother of Martha and Mary (as in the charter of the leper-house at
Sherburn) became the patron of lepers. The ascription to Lazarus of
Bethany of the malady of Lazarus in the parable has done much for the
prestige of the latter’s disease; in the medieval world it brought all
persons full of sores within a nimbus of sanctity, as being in a special
sense “pauperes Christi,” the successors at once of him whom Jesus loved
and of “Lazarus ulcerosus.” Doubtless the lepers deserved all the charity
that they got; but we shall not easily understand the interest
exceptionally taken in them, amidst abounding suffering and wretchedness
in other forms, unless we keep in mind that they somehow came to be
regarded as Christ’s poor.
Next to the image of Lazarus, or rather the composite image of the two
Lazaruses, the picture of leprosy that filled the imagination was that of
the thirteenth and fourteenth chapters of Leviticus. That picture is even
more composite than the other, and for leprosy in the strict sense it is
absolutely misleading. The word translated “leprosy” is a generic term for
various communicable maladies, most of which were curable within a
definite period, sometimes no longer than a week. It rested with the skill
of the priesthood to discriminate between the forms of communicable
disease, and to prescribe the appropriate ceremonial treatment for each;
the people had one common name for them all, and beyond that they were in
the hands of their priests, who knew quite well what they were about. The
Christian Church dealt with all those archaic institutions of an Eastern
people in a child-like spirit of verbal or literal interpretation,
doubtless finding the greater part of them a meaningless jargon. But some
verses would touch the imagination and call up a real and vivid picture,
such verses, for example, as the following:
“And the leper in whom the plague is, his clothes shall be rent, and
his head bare, and he shall put a covering upon his upper lip, and
shall cry, Unclean, unclean. All the days wherein the plague shall be
in him he shall be defiled; he is unclean; he shall dwell alone;
without the camp shall his habitation be.”
Even in that comparatively plain direction, the obvious suggestion that
the unclean person would not always be unclean, and that there was a term
to his stay outside the camp, would go for little in reading the
scripture. The medieval religious world took those parts of the Jewish
teaching that appealed to their apprehension, and applied them to the
circumstances of their own time with as much of zeal as the common sense
of the community would permit. We have clear evidence of the effect of the
Levitical teaching about “leprosy” upon English practice in the ordinances
of the St Albans leper hospital of St Julian, which will be given in the
sequel.
The Medieval Religious Sentiment towards Lepers.
Several incidents told of lepers by the chroniclers bring out that
exaggerated religious view of the disease. Roger of Howden has preserved
the following mythical story of Edward the Confessor. Proceeding one day
from his palace to the Abbey Church in pomp and state, he passed with his
train of nobles and ecclesiastics through a street in which sat a leper
full of sores. The courtiers were about to drive the wretched man out from
the royal presence, when the king ordered them to let him sit where he
was. The leper, waxing bold after this concession, addressed the king, “I
adjure thee by the living God to take me on thy shoulders and bring me
into the church;” whereupon the king bowed his head and took the leper
upon his shoulders. And as the king went, he prayed that God would give
health to the leper; and his prayer was heard, and the leper was made
whole from that very hour, praising and glorifying God[161].
It is not the miraculous ending of this incident that need surprise us
most; for the Royal touch by which the Confessor wrought his numerous
cures of the blind and the halt and the scrofulous, continued to be
exercised, with unabated virtue, down to the eighteenth century, and came
at length to be supervised by Court surgeons who were fellows of the Royal
Society. It is the humility of a crowned head in the presence of a leper
that marks an old-world kind of religious sentiment. The nearest approach
to it in our time is the feet-washing of the poor by the empress at Vienna
on Corpus Christi day.
A similar story, with a truer touch of nature in it, is told of Matilda,
queen of Henry I.; and it happens to be related on so good authority that
we may believe every word of it. Matilda was a Saxon princess, daughter of
Margaret the Atheling, the queen of Malcolm Canmore. The other actor in
the story was her brother David, afterwards king of Scots and, like his
mother, honoured as a saint of the Church. The narrator is Aelred, abbot
of Rievaulx, in the North Riding of Yorkshire, celebrated for his Latin
style and his care for Saxon history. The abbot was a friend of St David,
whose virtues he celebrates at length; the incident of queen Matilda and
the lepers was one that he often heard from David’s own lips (quod ex ore
saepe Davidis regis audivi). The princess Matilda, taking more after her
mother than her father, had been brought up in an English convent under
her aunt, the abbess of it. When it came to a marriage between her and
Henry I., an alliance which was meant to reconcile the Saxons to Norman
rule, the question arose in the mind of Anselm whether the princess
Matilda had not actually taken the veil, and whether he could legally
marry her to the king. Questioned as to the fact, the princess made answer
that she had indeed worn the veil in public, but only as a protection from
the licentious insolence of the Norman nobles. She had no liking for the
great match arranged for her, and consented unwillingly although the king
was enamoured of her. Such was her humility that Aelred designates her
“the Esther of our times.” The marriage was on the 15th of November, 1100;
and in the next year, according to the usual date given, the young queen
sought relief and effusion for her religious instincts by founding the
leper hospital of St Giles in the Fields, “with a chapel and a sufficient
edifice.” Matthew Paris, a century and a half after, saw it standing as
queen Matilda had built it, and made a sketch of it in colours on the
margin of his page, still remaining to us in a library at Cambridge, with
the description, “Memoriale Matild. Regine.”
The story which her brother David told to the abbot of Rievaulx is as
follows:
When he was serving as a youth at the English Court, one evening he
was with his companions in his lodging, when the queen called him into
her chamber. He found the place full of lepers, and the queen standing
in the midst, with her robe laid aside and a towel girt round her.
Having filled a basin with water, she proceeded to wash the feet of
the lepers and to wipe them with the towel, and then taking them in
both her hands, she kissed them with devotion. To whom her brother:
“What dost thou, my lady? Certes if the king were to know this, never
would he deign to kiss with his lips that mouth of thine polluted with
the soil of leprous feet.” But she answered with a smile: “Who does
not know that the feet of an Eternal King are to be preferred to the
lips of a mortal king? See, then, dearest brother, wherefore I have
called thee, that thou mayest learn by my example to do so also. Take
the basin, and do what thou hast seen me do.” “At this,” said David,
narrating to the abbot, “I was sore afraid, and answered that I could
on no account endure it. For as yet I did not know the Lord, nor had
His Spirit been revealed to me. And as she proceeded with her task, I
laughed--_mea culpa_--and returned to my comrades[162].”
The example of his sister, however, was not lost upon him; for when he
acquired the earldom and manor of Huntingdon, and so became an opulent
English noble, he founded a leper-hospital there. Aelred sees him in
Abraham’s bosom with Lazarus.
The meaning of all this devotion to lepers is shown in the name which
Aelred applies to them--_pauperes Christi_. In washing their feet the
pious Matilda was in effect washing the feet of an Eternal King; and that,
in her estimation, was better than kissing the lips of a mortal king.
Again, in the Life of St Hugh of Lincoln we see the good bishop moved to
treat the leprous poor with a sort of attention which they can hardly have
needed or expected, merely because they were, as his biographer says, the
successors of _Lazarus ulcerosus_, and the special _protegés_ of Jesus.
Not a few, says the biographer, were kept in seclusion owing to that
disease, both men and women. Bishop Hugh would take up his abode among
them and speak to them words of good cheer, promising them the flowers of
Paradise and an immortal crown. Having sent the women lepers out of the
way, he would go round among the men to kiss them, and when he came to one
who was more atrociously marked by the disease than another, he would hold
him in a longer and more gracious embrace. It was too much for the
bishop’s biographer: “Spare, good Jesus, the unhappy soul of him who
relates these things”--horrified, as he says he was, at seeing the
“swollen and livid faces, deformed and sanious, with the eyelids everted,
the eyeballs dug out, and the lips wasted away, faces which it were
impossible to touch close or even to behold afar off[163]”. But these
horrible disfigurements of the face are by no means the distinctive marks
of leprosy. The dragging down of the eyelids is an effect of leprosy but
as likely to happen in lupus or rodent ulcer. The loss of the eyeball may
be a leprous sign, or perhaps from tumour. The wasting of the lips is a
characteristic feature of lupus, after it has scarred, or if there be an
actual loss of substance, of epithelial cancer; in leprosy, on the other
hand, the lips, as well as other prominent folds of the face, undergo
thickening, and will probably remain thickened to the end. The sufferers
who excited the compassion of St Hugh must have merited it; only they were
not all lepers, nor probably the majority of them[164].
Two leper-stories are told to the honour of St Francis of Assisi. Seeing
one day a friar of his order named James the Simple, consorting on the way
to church with a leper from the hospital under his care, St Francis
rebuked the friar for allowing the leper to be at large. While he thus
admonished the friar, he thought that he observed the leper to blush, and
was stricken with a sudden remorse that he should have said anything to
hurt the wretched man’s feelings. Having confessed and taken counsel, he
resolved, by way of penance, to sit beside the leper at table and to eat
with him out of the same dish, a penance all the greater, says the
biographer, that the leper was covered all over with offensive sores and
that the blood and sanies trickled down his fingers as he dipped them in
the dish. The other story is a more pleasing one. There was a certain
leper among those cared for by the friars, who would appear from the
description of him to have been one of the class of truculent impostors,
made all the worse by the morbid consideration with which his disease, or
supposed disease, was regarded. One of his complaints was that no one
would wash him; whereupon St Francis, having ordered a friar to bring a
basin of perfumed water, proceeded to wash the leper with his own
hands[165].
These four tales, all of them told of saints except that of Matilda--she
somehow missed being canonised along with her mother St Margaret and her
brother St David--will serve to show what a halo of morbid exaggeration
surrounded the idea of leprosy in the medieval religious mind. We live in
a time of saner and better-proportioned sentiment; but the critical
spirit, which has set so much else in a sober light, has spared the
medieval tradition of leprosy. Not only so, but our more graphic writers
have put that disease into the medieval foreground as if it had been the
commonest affliction of the time. We are taught to see the figures of
lepers in their grey or russet gowns flitting everywhere through the
scene; the air of those remote times is as if filled with the dull
creaking of St Lazarus’s rattle. Our business here is to apply to the
question of leprosy in medieval Britain the same kind of scrutiny which
has been applied to the question of famines and famine-fevers, and remains
to be applied next in order to the great question of plague--the kind of
scrutiny which no historian would be excused from if his business were
with politics, or campaigns, or economics, or manners and customs. The
best available evidence for our purpose is the history of the
leper-houses, to which we shall now proceed.
The English Leper-houses.
The English charitable foundations, or hospitals of all kinds previous to
the dissolution of the monasteries, including almshouses, infirmaries,
Maisons Dieu and lazar-houses, amount to five hundred and nine in the
index of Bishop Tanner’s _Notitia Monastica_. In the 1830 edition of the
_Monasticon Anglicanum_, the latest recension of those immense volumes of
antiquarian research, there are one hundred and four such foundations
given, for which the original charters, or confirming charters, or reports
of inquisitions, are known; and, besides these, there are about three
hundred and sixty given in the section on “Additional Hospitals,” the
existence and circumstances of which rest upon such evidence as casual
mention in old documents, or entries in monastery annals, or surviving
names and traditions of the locality. Our task is to discover, if we can,
what share of this charitable provision in medieval England, embracing at
least four hundred and sixty houses, was intended for the class of
_leprosi_; what indications there are of the sort of patients reckoned
_leprosi_; how many sick inmates the leper-houses had, absolutely as well
as in proportion to their clerical staff; and how far those refuges were
in request among the people, either from a natural desire to find a refuge
or from the social pressure upon them to keep themselves out of the way.
It is clear that the endowed hospitals of medieval England were in no
exclusive sense leper-hospitals, but a general provision, under religious
discipline, for the infirm and sick poor, for infirm and ailing monks and
clergy, and here or there for decayed gentlefolk. The earliest of them
that is known, St Peter’s and St Leonard’s hospital at York, founded in
936 by king Athelstane, and enlarged more especially on its religious side
by king Stephen, was a great establishment for the relief of the poor,
with no reference to leprosy; it provided for no fewer than two hundred
and six bedesmen, and was served by a master, thirteen brethren, four
seculars, eight sisters, thirty choristers and six servitors. When
Lanfranc, the first Norman archbishop of Canterbury, set about organising
the charitable relief of his see in 1084, he endowed two hospitals, one
for the sick and infirm poor in general, and the other for _leprosi_[166].
The former, St John Baptist’s hospital, was at the north gate, a
commodious house of stone, for poor, infirm, lame or blind men and women.
The latter was the hospital of Herbaldown, an erection of timber, in the
woods of Blean about a mile from the west gate, for persons _regia
valetudine fluentibus_ (?), who are styled _leprosi_ in a confirming
charter of Henry II.[167] The charge of both these houses was given to the
new priory of St Gregory, over against St John Baptist’s hospital, endowed
with tithes for secular clergy. The leper-house at Herbaldown was divided
between men and women; but in a later reign (Henry II.) a hospital
entirely for women (twenty-five leprous sisters) was founded at
Tannington, outside Canterbury, with a master, prioress and three priests.
There was still a third hospital at Canterbury, St Lawrence’s, founded
about 1137, for the relief of leprous monks or for the poor parents and
relations of the monks of St Augustine’s.
London had two endowed leper-hospitals under ecclesiastical government, as
well as certain spitals or refuges of comparatively late date. The
hospital and chapel of St Giles in the Fields was founded, as we have
seen, by Matilda, queen of Henry I., in 1101, and was commonly known for
long after as Matilda’s hospital. It was built for forty _leprosi_, who
may or may not all have lived in it; and it was supported in part by the
voluntary contributions of the citizens collected by a proctor. Its staff
was at first exceptionally small for the number of patients,--a chaplain,
a clerk and a messenger; but as its endowments increased several other
clerics and some matrons were added. By a king’s charter of 1208 (10th
John), it was to receive sixty shillings annually. It is next heard of, in
the Rolls of Parliament, in connexion with a petition of 1314-15 (8 Ed.
II.), by the terms of which, and of the reply to it, we can see that there
were then some lepers in the hospital but also patients of another kind.
It is mentioned by Wendover, under the year 1222, as the scene of a trial
of strength between the citizens and the _comprovinciales extra urbem
positos_[168]: at that date it stood well in the country, probably near to
where the church of St Giles now stands at the end of old High Holborn.
The drawing of the hospital on the margin of Matthew Paris’s manuscript
shows it as a house of stone, with a tower at the east end and a smaller
one over the west porch, and with a chapel and a hall, but probably no
dormitories for forty lepers[169].
The other endowed leper-house of the metropolis was the hospital of St
James, in the fields beyond Westminster. It was of ancient date, and
provided for fourteen female patients, who came somehow to be called the
_leprosae puellae_[170], although youth is by no means specially
associated with leprosy. This house grew rich, and supported eight
brethren for the religious services of the sixteen patients[171].
It is usual to enumerate five, and sometimes six, other leper-hospitals,
in the outskirts of London--at Kingsland or Hackney, in Kent Street,
Southwark (the Lock), at Highgate, at Mile End, at Knightsbridge and at
Hammersmith. But the earliest of these were founded in the reign of Edward
III. (about 1346) at a time when the old ecclesiastical leper-houses were
nearly empty of lepers. It would be misleading to include them among the
medieval leper-houses proper, and I shall refer to them in a later part of
this chapter.
The example of archbishop Lanfranc at Canterbury and of queen Matilda in
London was soon followed by other founders and benefactors. The movement
in favour of lepers--there was probably too real an occasion for it to
call it a craze--gained much from the appearance on the scene of the
Knights of the Order of St Lazarus of Jerusalem. Those knights were the
most sentimental of the orders of chivalry, and probably not more
reputable than the Templars or the main body of the Hospitallers from
which they branched off. If we may judge of them by modern instances, they
wanted to do some great thing, and to do it in the most theatrical way,
with everybody looking on. What real services they may have rendered to
the sick poor, leprous or other, there is little to show. The
head-quarters of the order were at Jerusalem, the Grand Master and the
Knights there being all _leprosi_--doubtless in a liberal sense of the
term. We should be doing them no injustice if we take them to have been
Crusaders so badly hit by their vices or their misfortunes as to be marked
off into a separate order by a natural line. However, many others enlisted
under the banner of St Lazarus who were not _leprosi_; these established
themselves in various countries of Europe, acquired many manors and built
fine houses[172]. In England their chief house was at Burton in
Leicestershire; it was not by any means a great leper-hospital, but a
Commandery or Preceptory for eight whole knights, with some provision for
an uncertain number of poor brethren--the real Lazaruses who, like their
prototype, would receive the crumbs from the high table. The house of
Burton Lazars gradually swallowed up the lands of leper-hospitals
elsewhere, as these passed into desuetude, and at the valuation of Henry
VIII. it headed the list with an annual rental of £250. Their
establishment in England dates from the early part of the twelfth century,
and although the house at Burton appears to have been their only
considerable possession, they are said, on vague evidence, to have
enlisted many knights from England, and, curiously enough, still more from
Scotland. A letter is extant by the celebrated schoolman, John of
Salisbury, afterwards bishop of Chartres, written in the reign of Henry
II. to a bishop of Salisbury, from which it would appear that the “Fratres
Hospitales” were regarded with jealousy and dislike by the clerical
profession; “rapiunt ut distribuant,” says the writer, as if there were
something at once forced and forcible in their charities[173].
Coincidently with the appearance in England of the Knights of St Lazarus,
we find the monasteries, and sometimes private benefactors among the
nobility, beginning to make provision for lepers, either along with other
deserving poor or in houses apart. After the hospitals at Canterbury and
London (as well as an eleventh-century foundation at Northampton, which
may or may not have been originally destined for _leprosi_), come the two
leper-houses founded by the great abbey of St Albans. As these were
probably as good instances as can be found, their history is worth
following.
In the time of abbot Gregory (1119 to 1146), the hospital and church of St
Julian was built on the London road, for six poor brethren (_Lazares_ or
_pauperes Christi_) governed by a master and four chaplains. The
mastership of St Julian’s is twice mentioned in the abbey chronicles as a
valuable piece of preferment. In 1254 the lands of the hospital were so
heavily taxed, for the king and the pope, that the _miselli_, according to
Matthew Paris, had barely the necessaries of life. But a century after,
in 1350, the revenues were too large for its needs, and new statutes were
made; the accommodation of its six beds was by no means in request, the
number of inmates being never more than three, sometimes only two, and
occasionally only one[174]. The fate of the other leper-house of St Albans
abbey, that of St Mary de Pratis for women, is not less instructive. The
date of its foundation is not known, but in 1254 it had a church and a
hospital occupied by _misellae_[175]. A century later we hear of the house
being shared between illiterate sisters and nuns. The former are not
called lepers, but simply poor sisters; whatever they were, the nuns and
they did not get on comfortably together, and the abbot restored harmony
by turning the hospital into a nunnery pure and simple[176]. Similar was
the history of one of the richest foundations of the kind, that of Mayden
Bradley in Wiltshire. It was originally endowed shortly before or shortly
after the accession of Henry II. (1135) by a noble family for an unstated
number of poor women, generally assumed to have been _leprosae_, and for
an unstated number of regular and secular clerics to perform the religious
offices and manage the property. It had not existed long, however, when
the bishop of Salisbury, in 1190, got the charter altered so as to assign
the revenues to eight canons and--poor sisters, and so it continued until
the valuation of Henry VIII., when it was found to be of considerable
wealth. In like manner the hospital of St James, at Tannington near
Canterbury, founded in the reign of Henry II. for twenty-five “leprous
sisters,” was found, in the reign of Edward III. (1344), to contain no
lepers, its “corrodies” being much sought after by needy gentlewomen[177].
Another foundation of Henry II.’s reign was the leper-hospital of St Mary
Magdalen at Sponne, outside the walls of Coventry. It was founded by an
Earl of Chester, who, having a certain leprous knight in his household,
gave in pure alms for the health of his soul and the souls of his
ancestors his chapel at Sponne with the site thereof, and half a carucate
of land for the maintenance of such lepers as should happen to be in the
town of Coventry. There was one priest to celebrate, and with him were
wont to be also certain brethren or sisters together with the lepers,
praying to God for the good estate of all their benefactors. “But clear it
is,” says Dugdale, “that the monks shortly after appropriated it to their
own use.” However, they were in time dispossessed by the Crown, to which
the hospital belonged until the 14th of Edward IV[178].
One of the most typical as well as earliest foundations was the hospital
of the Holy Innocents at Lincoln, endowed by Henry I. We owe our knowledge
of its charter to an inquisition of Edward III. It was intended for ten
_leprosi_, who were to be of the outcasts (_de ejectibus_) of the city of
Lincoln, the presentation to be in the king’s gift or in that of the mayor
or other good men of the city, and the administration of it by a master or
warden, two chaplains and one clerk. In the space of two centuries from
its foundation the character of its inmates had gradually changed. Edward
III.’s commissioners found nine poor brethren or sisters in it; only one
of them was _leprosus_, and he had obtained admission by a golden key;
also the seven poor women had got in _per viam pecuniam_. In Henry VI.’s
time provision was made for the possibility of lepers still requiring its
shelter--_quod absit_, as the new charter said.
In the same reign (end of Henry I.) the hospital of St Peter was founded
at Bury St Edmunds by abbot Anselm, for priests and others when they grew
old and infirm, leprous or diseased. The other hospital at Bury, St
Saviour’s, had no explicit reference to leprosy at all. It was founded by
the famous abbot Samson about 1184, for a warden, twelve chaplain-priests,
six clerks, twelve poor gentlemen, and twelve poor women. About a hundred
years later the poor sisters had to go, in order to make room for old and
infirm priests.
Sometime before his death in 1139, Thurstan, archbishop of York, founded a
hospital at Ripon for the relief of “all the lepers in Richmondshire;” the
provision was for eighteen patients, a chaplain and sisters. At an
uncertain date afterwards the house was found to contain a master, two or
three chaplains and some brethren, who are not styled _leprosi_; and from
the inquisition of Edward III. we learn that its original destination had
been for the relief as much of the poor as the leprous (_tam pauperum quam
leprosorum_), and that there was no leprous person in it at the date of
the inquisition.
The mixed character of hospitals commonly reckoned leper-hospitals is
shown by several other instances. St Mary Magdalene’s at Lynn (1145)
provided for a prior and twelve brethren or sisters, nine of whom were to
be whole and three leprous. St Leonard’s at Lancaster (time of king John)
was endowed for a master, a chaplain, and nine poor persons, three of them
to be leprous. St Bartholomew’s at Oxford provided for a master, a clerk,
two whole brethren and six infirm or leprous brethren; but the infirm or
leprous brethren had all been changed into whole brethren by the time of
Edward III[179]. So again the Normans’ spital at Norwich was found to be
sheltering “seven whole sisters and seven half-sisters.”
The leper-hospital at Stourbridge, near Cambridge, was founded for lepers
by king John, the one king in English history who cared greatly about his
leprous subjects. It was committed to the charge of the burgesses of
Cambridge, but it was shortly after seized by Hugo de Norwold, bishop of
Ely, and within little more than fifty years from its foundation (7 Ed.
I.) it was found that the bishop of Ely of that day was using it for some
purposes of his own, but “was keeping no lepers in it, as he ought, and as
the custom had been[180].”
The ostentatious patronage of lepers by king John, of which something more
might be said, was preceded by a more important interposition on their
behalf by the third Council of the Lateran in 1179 (Alexander III.). The
position of _leprosi_ in the community had clearly become anomalous, and
one of the decrees of the Council was directed to setting it right.
Lepers, who were “unable to live with sound persons, or to attend church
with them, or to get buried in the same churchyard, or to have the
ministrations of the proper priest,” were enjoined to have their own
presbytery, church, and churchyard, and their lands were to be exempt from
tithe[181]. Within two or three years of that decree, in or near 1181, we
find a bishop of Durham, Hugh de Puiset, endowing the greatest of all the
English leper-hospitals, at Sherburn, a mile or more outside the city of
Durham. The bishop was a noted instance of the worldly ecclesiastic of his
time. He was accused by the king of misappropriating money left by the
archbishop of York, and his defence was that he had spent it on the blind,
the deaf, the dumb, the leprous, and such like deserving objects[182].
William of Newburgh has left us his opinion of the bishop’s charity: it
was a noble hospital lavishly provided for, “but with largess not quite
honestly come by” (_sed tamen ex parte minus honesta largitione_[183]).
The hospital of bishop Hugh, dedicated to the Saviour, the Blessed Virgin,
St Lazarus, and his sisters Mary and Martha, still exists as Christ’s
Hospital, a quadrangular building enclosing about an acre in a sunny
valley to the south of the city, with a fine chapel, a great hall (of
which the ancient raftered roof existed into the present century), a
master’s lodge, and a low range of buildings on the west side of the
square for the poor brethren, with their own modest hall in the middle of
it. The original foundation was certainly on a princely scale, as things
then went: it was for five “convents” of lepers, including in all
sixty-five persons of both sexes, with a steward or guardian to be their
own proper representative or protector, three priests, four attendant
clerks, and a prior and prioress. We hear nothing more of the hospital for
a century and a half, during which time it had doubtless been filled by a
succession of poor brethren, or sick poor brethren, but whether leprous
brethren, or even mainly leprous, may well be doubted after the recorded
experiences of Ripon, Lincoln and Stourbridge. Its charter was confirmed
by bishop Kellaw about 1311-1316; and in an ordinance of 1349 we still
read, but not without a feeling of something forced and unreal, of the
hospital ministering to the hunger, the thirst, the nakedness of the
leprous, and to the other wants and miseries by which they are incessantly
afflicted. But within ninety years of that time (1434) the real state of
the case becomes apparent; the poor brethren had been neglected, and the
estates so mismanaged or alienated to other uses, that new statutes were
made reducing the number of inmates to thirteen poor brethren and two
lepers, the latter being thrown in, “if they can be found in these parts,”
in order to preserve the memory of the original foundation[184].
To these samples, which are also the chief instances of English
leper-hospitals, may be added two or three more to bring out another side
of the matter. In the cases already given, it has been seen that the
provision for the clerical staff was either a very liberal one at first or
became so in course of time. The hospitals, whether leprous or other, were
for the most part dependencies of the abbeys, affording occupation and
residence to so many more monks, just as if they had been “cells” of the
abbey. The enormous disproportion of the clerical staff to the inmates of
hospitals (not, however, leprous) is seen in the instances of St Giles’s
at Norwich, St Saviour’s at Bury and St Cross at Winchester. The provision
was about six for the poor and half-a-dozen for the monks. But even the
purely nosocomial part of these charities was in not a few instances for
the immediate relief of the monasteries themselves. St Bartholomew’s at
Chatham, one of the earliest foundations usually counted among the
leper-hospitals, was for sick or infirm monks. The hospital at
Basingstoke, endowed by Merton College, Oxford, was for incurably sick
fellows and scholars of Merton itself. The leper-hospital at Ilford in
Essex was founded about 1180 by the rich abbey of Barking, for the leprous
tenants and servants of the abbey, the provision being for a secular
master, a leprous master, thirteen leprous brethren, two chaplains and a
clerk. St Lawrence’s at Canterbury (1137) was for leprous monks or for the
poor parents and relations of monks. St Peter’s at Bury St Edmunds,
founded by abbot Anselm in the reign of Henry I., was for priests and
others when they grew old, infirm, leprous, or diseased.
The instances which have been detailed in the last few pages, perhaps not
without risk of tediousness, have not been chosen to give a colour to the
view of medieval leprosy; they are a fair sample of the whole, and they
include nearly all those leper-hospitals of which the charters or other
authentic records are known[185]. It is possible by using every verbal
reference to leprosy that may be found in connexion with all the five
hundred or more medieval English hospitals in Bishop Tanner’s _Notitia
Monastica_ or in Dugdale’s _Monasticon_, to make out a list of over a
hundred leper-hospitals of one kind or another. But there are probably not
thirty of them for which the special destination of the charity is known
from charters or inquisitions; and even these, as we have seen, were not
all purely for lepers or even mainly for lepers. As to the rest of the
list of one hundred, the connexion with leprosy is of the vaguest kind.
Thus, four out of the five hospitals in Cornwall are called lazar-houses
or leper-hospitals, but they were so called merely on the authority of
antiquaries subsequent to the sixteenth century. The same criticism
applies almost equally to the eight so-called leper-hospitals, out of a
total of fourteen medieval hospitals of all kinds, in Devonshire. It is
clear that “lazar-house” became an even more widely generic term than the
terms _lepra_ and _leprosus_ themselves[186].
Thus our doubts as to the amount of true leprosy that once existed in
England, and was provided for in the access of chivalrous sentiment that
came upon Christendom in the twelfth and thirteenth centuries, tend to
multiply in a compound ratio. We doubt whether many of the so-called
leper-houses or lazar-houses in the list of one hundred, more or less,
that may be compiled from the _Monasticon_, were not ordinary refuges for
the sick and infirm poor, like the three or four hundred other religious
charities of the country. We know that, in some instances of
leper-hospitals with authentic charters, the provision for the leprous was
in the proportion of one to three or four of non-leprous inmates. We know
that as early as the end of the thirteenth century the _leprosi_ were
disappearing or getting displaced even from hospitals where the intentions
of the founder were explicit. And lastly we doubt the homogeneity of the
disease called _lepra_ and of the class called _leprosi_.
As to the foundations of a later age they were no longer under
ecclesiastical management, and they seem to have been mostly rude shelters
on the outskirts of the larger towns. In 1316 a burgess of Rochester, who
had sat in Parliament, left a house in Eastgate to be called St
Katharine’s Spital, “for poor men of the city, leprous or otherwise
diseased, impotent and poor”--or, in other words, a common almshouse. The
remarkable ordinance of Edward III. in 1346, for the expulsion of lepers
from London, seems to have been the occasion of the founding of two
so-called lazar-houses, one in Kent Street, Southwark, called “the
Loke[187],” and the other at Hackney or Kingsland. These are the only two
mentioned in the subsequent orders to the porters of the City Gates in
1375; and as late as the reign of Henry VI. they are the only two, besides
the ancient Matilda’s Hospital in St Giles’s Fields, to which bequests
were made in the will of Ralph Holland, merchant taylor[188]. Another of
the suburban leper-spitals was founded at Highgate by a citizen in
1468[189], and it is not until the reign of Henry VIII. that we hear of
the spitals at Mile End, Knightsbridge and Hammersmith[190]. By that time
leprosy had ceased to be heard of in England; but another disease,
syphilis, had become exceedingly common; and it is known that those
spitals, together with the older leper-hospitals, were used for the poorer
victims of that disease. Stow is unable to give the exact date of any of
these foundations except that at Highgate. He assumes that the others were
all built on the occasion of the ordinance of 20 Edward III.; but it is
probable that only two of them, the Lock and the Kingsland or Hackney
spital were built at that time[191].
An early instance of a leper-spital or refuge apparently without
ecclesiastical discipline is mentioned in a charter roll of 1207-8, in
which king John grants to the leprosi of Bristol a croft outside the
Laffard gate, whereon to reside under the king’s protection and to beg
with impunity. On the roads leading to Norwich there were four such
shelters, outside the gates of St Mary Magdalene, St Bennet, St Giles and
St Stephen respectively; these houses were each under a keeper, and were
supported by the alms of the townsfolk or of travellers; only one of the
four is alleged to have had a chapel attached. The date of these is
unknown, but they were probably late. On the roads leading from Lynn,
there were three such erections, at Cowgate, Letchhythe and West Lynn,
which are first mentioned in a will of 1432. These non-religious and
unendowed leper-spitals were probably rude erections on the outskirts of
the town, at the door of which, or on the roadside near, one or more
lepers would sit and beg. The liberty of soliciting alms was one of their
privileges, only they were not allowed to carry their importunity too far;
hence the ordinance of most countries that the lepers were not to enter
mills and bake-houses; and hence some ordinances of the Scots parliament
limiting the excursions of the leper folk. One of the most considerable
privileges to lepers was granted to the lepers of Shrewsbury in 1204 by
king John, who did not lose the chance of earning a cheap reputation for
Christian charity by his ostentatious patronage of the _pauperes Christi_:
they were entitled to take a handful of corn or flour from all sacks
exposed in Shrewsbury market.
Leper-houses in Scotland and Ireland.
Most of the leper-spitals of Scotland would appear to have been of the
poorest kind, unendowed and unprovided with priests. The richest
foundation for lepers in Scotland was at Kingcase, near Prestwick in
Ayrshire, endowed with lands and consisting of a hospital of eight beds.
One or more leper-hospitals were built by the rich abbeys on the Tweed (at
Aldcambus in Berwickshire and probably at another place). Another great
ecclesiastical centre in Scotland, Elgin, had a leper-house at Rothfan,
with accommodation for seven lepers, a chaplain, and a servant. After
these, the Scots leper-houses may be taken to have been mere refuges, in
which the lepers supported themselves by begging. One such secular
hospital was in the Gorbals of Glasgow, founded in 1350. Liberton, near
Edinburgh, is supposed to mean Leper-town, and to have been a resort of
the sick on account of its medicinal spring. The hospital at Greenside,
then outside Edinburgh, was built in 1589. There was a leper-spital
outside the Gallow-gate of Aberdeen, on a road which still bears the name
of the Spital. Similar shelters may be inferred to have existed at Perth,
Stirling, Linlithgow and other places. James IV., in his journeys, used to
distribute small sums to the sick folk in the “grandgore” (syphilis), to
the poor folk, and to the lipper-folk, “at the town end[192].”
There were some leper-hospitals in Ireland, but it is not easy to
distinguish them in every case from general hospitals for the sick poor.
Thus the hospital built by the monks of Innisfallen in 869 is merely
called _nosocomium_, although it is usually reckoned an early foundation
for lepers in Ireland. A hospital at Waterford was “confirmed to the poor”
by the Benedictines in 1185. St Stephen’s in Dublin (1344) is specially
named as the residence of the “poor lepers of the city” in a deed of gift
about 1360-70; a locality of the city called Leper-hill was perhaps the
site of another refuge. Lepers also may have been the occupants of the
hospitals at Kilbrixy in Westmeath (St Bridget’s), of St Mary Magdalene’s
at Wexford (previous to 1408), of the house at “Hospital,” Lismore (1467),
at Downpatrick, at Kilclief in county Down, at Cloyne, and of one or more
of four old hospitals in or near Cork. The hospital at Galway, built “for
the poor of the town” about 1543, was not a leper-house, nor is there
reason to take the old hospital at Dungarvan as a foundation specially for
lepers[193].
The Prejudice against Lepers.
It will have been inferred, from many particulars given, that the
segregation of lepers in the Middle Ages was far from complete, and that
many ministered to them without fear and without risk. The same hospital
received both _leprosi_ and others, the hospitals were served by staffs of
chaplains, clerks and sometimes women attendants; and yet nothing is
anywhere said of contagion being feared or of the disease spreading by
contagion. The experience of these medieval hospitals was doubtless the
same as in the West Indies and other parts of the world in our own day.
It is true that the medical writers pronounce the disease to be
contagious, _ut docet Avicenna_; but the public would seem to have been
unaware of that, and they certainly lost nothing by their ignorance of the
medical dogma, which, in the text-books, is merely the result of a
concatenation of verbalist arguments. At the same time it is clear that
there was a certain amount of segregation of the leprous. The inmates of
the hospital at Lincoln are significantly described as “de ejectibus” of
the city. The third Lateran Council based one of its decrees upon what
must have been a common experience, namely, that lepers were unable to mix
freely with others, and that they were objected to in the same church, and
even as corpses in the same churchyard. There are some particular
indications of that feeling to be gathered from the chroniclers.
One of the most remarkable histories is that of a high ecclesiastic in the
pre-Norman period. In the year 1044, Aelfward, bishop of London, being
stricken with leprosy (_lepra perfusus_) sought an asylum in the monastery
of Evesham, of which he was the prior. The monks may have had more than
one reason for not welcoming back their prior; at all events they declined
to let him stay, so that he repaired to the abbey of Ramsey, where he had
passed his noviciate and been shorn a monk. He carried off with him from
Evesham certain valuables and relics; and his old comrades at Ramsey,
undeterred by his leprosy or counter-attracted by his treasures, took him
in and kept him until his death. The incident can hardly be legendary for
it is related in the annals of Ramsey Abbey by one who wrote within a
hundred years of the event[194].
Another case, which may also be accepted as authentic, is given by Eadmer
in his _Life of Anselm_. Among the penitents who sought counsel and
consolation of Anselm while he was still abbot of Bec in Normandy, with a
great name for sanctity, was a certain powerful noble from the marches of
Flanders. He had been stricken with leprosy in his body, and his grief was
all the greater that he saw himself despised beneath his hereditary rank,
and shunned by his peers _pro obscenitate tanti mali_[195].
Besides such notable cases, we find more evidence in the ordinances of the
hospital of St Julian at St Albans, which have been preserved more
completely than those of any other leper-house. Forasmuch as the disease
of leprosy is of all infirmities held the most in contempt, the
unfortunate person who is about to be received into the St Albans house is
directed to work himself up into a state of the most factitious
melancholy; he is reminded, not only of the passage in Leviticus about
“Unclean, unclean!”, but also of the blessed Job, who was himself a leper
(in the 14th century his boils became identified with the plague, and in
the end of the 15th century the patriarch was claimed as an early victim
of the _lues venerea_); and further of the verse in the 53rd of Isaiah:
“Et nos putavimus eum leprosum, percussum a Deo, et humiliatum[196].” The
St Albans house, with its six beds, appears to have been carefully
managed, and its inmates well provided for; but the unreal atmosphere of
the place had been too much for the leprous or other patients of the
district; for we find it on record that they could hardly be persuaded to
don its russet uniform, and submit themselves for the rest of their lives
to its discipline.
There can be no question, then, that persons adjudged leprous were
shunned, driven out or ostracised by public opinion, and even legislated
against. The reality of these practices should not be confounded with a
real need for them. Least of all should they be ascribed to a general
belief in the contagiousness of the disease. In practice no one heeded the
medical dogma of leprous contagion, because no one attached any concrete
meaning to it or had any real experience of it. There was prejudice
against lepers, partly on account of Biblical tradition, and partly
because the “terribilis aspectus” of a leper was repulsive or uncanny.
Further, in genuine leprosy, the most wretched part of the victim’s
condition was not his appearance (which in a large proportion of cases
may present little that is noticeable to passing observation), but his
unfitness for exertion, his listlessness, and depression of spirits, owing
to the profound disorganisation of his nerves. A leprous member of a
family would be a real burden to his relatives; and in a hard and cruel
age he would be little better off than the stricken deer of the herd or
the winged bird of the flock. To become a beggar was his natural fate; and
as a beggar he became privileged, by royal patent or by prescription,
while beggars in ordinary were under a ban.
It is undoubted that the privilege of begging accorded to lepers was
abused, and was claimed by numbers who feigned to be lepers[197]. The one
severe edict against lepers in England was the ordinance of Edward III.
for the exclusion of lepers from London in 1346; it is clear, however,
from the text of the ordinance that the occasion of it was not any fixed
persuasion of the need for isolating leprous subjects, but some
intolerable behaviour of lepers or of those who passed as such. The mayor
and sheriffs are ordered to procure that all lepers should avoid the city
within fifteen days, for the reason that persons of that class, as well by
the pollution of their breath, etc. “as by carnal intercourse with women
in stews and other secret places, detestably frequenting the same, do so
taint persons who are sound, both male and female, to the great injury
etc.[198]” That is the old confusion which we have already noticed in
Bernard Gordonio and Gilbert; it is an edict against _lepra_ in its
generic sense, and against the same class that William Clowes
characterizes so forcibly in his book on the _morbus Gallicus_ in 1579. At
a date intermediate between those two, in 1488, an order was made by the
provost of Paris, that “lepers” should leave the city; but that is too
late a date for leprosy, although not too early for syphilis. On the 24th
August, 1375, the porters of the City Gates were sworn to prevent lepers
from entering the city, or from staying in the same, or in the suburbs
thereof; and on the same date, the foreman at ‘Le Loke’ (the Lock Hospital
in Southwark) and the foreman at the leper-spital of Hackney took oath
that they will not bring lepers, or know of their being brought, into the
city, but that they will inform the said porters and prevent the said
lepers from entering, so far as they may[199].
When all word of leprosy had long ceased in England the porters of the
City Gates had the same duties towards beggars in general. Thus in
Bullein’s _Dialogue_ of 1564, the action begins with a whining beggar from
Northumberland saying the Lord’s Prayer at the door of a citizen. The
citizen asks him, “How got you in at the gates?” whereupon it appears that
the Northumbrian had a friend at Court: “I have many countrymen in the
city,” among the rest an influential personage, the Beadle of the
Beggars[200].
While it cannot be maintained that lepers were tolerated or looked upon
with indifference, yet it was for other reasons than fear of contagion
that they were objectionable. The prejudices against them have been
already illustrated from periods as early as the eleventh century. They
were, to say the least, undesirable companions, and in certain occupations
they must have been peculiarly objectionable. Thus, on the 11th June,
1372, in the city of London, John Mayn, baker, who had often times before
been commanded by the mayor and aldermen to depart from the city, and
provide for himself some dwelling without the same, and avoid the common
conversation of mankind, seeing that he the same John was smitten with the
blemish of leprosy--was again ordered to depart[201]. It does not appear
whether the baker departed that time, nor is there any good diagnosis of
his leprosy; there was certainly a prejudice against him, but the occasion
of it may have been nothing more than the eczematous crusts on the hands
and arms, sometimes very inveterate, which men of his trade are subject
to.
It is clear also from a singular case in the _Foedera_, that a false
accusation of leprosy was sometimes brought against an individual, perhaps
out of enmity, like an accusation of witchcraft. In 1468 a woman accused
of leprosy appealed to Edward IV., who issued a chancery warrant for her
examination.
The writ of 3rd July, 1468, is to the king’s physicians, “sworn to the
safe-keeping of our person,” William Hatteclyff, Roger Marschall, and
Dominic de Serego, doctors of Arts and Medicine; and the subject of
the inquisition is Johanna Nightyngale of Brentwood in Essex, who was
presumed by certain of her neighbours to be infected by the foul
contagion of _lepra_, and for whose removal from the common
intercourse of men a petition had been laid in Chancery. She had
refused to remove herself to a solitary place, _prout moris est_; the
physicians are accordingly ordered to associate with themselves
certain legal persons, to inquire whether the woman was leprous, and,
if so, to have her removed to a solitary place _honestiori modo quo
poteris_. On the 1st of November, 1468, the court of inquiry reported
that they found the woman to be in no way leprous, nor to have been.
The woman had been brought before them: they had passed in review
twenty-five or more of the commonly reputed signs of _lepra_, but they
had not found that she could be convicted of leprosy from them, or
from a sufficient number of them; again, passing in review each of the
four species of lepra (_alopecia_, _tinia_, _leonina_, and
_elephantia_) and the forty or more distinctive signs of the species
of _lepra_, they found not that the woman was marked by any of the
species of _lepra_, but that she was altogether free and immune from
every species of _lepra_[202].
Laws against Lepers.
The ordinance of 21 Edward III. (1346) against the harbouring of lepers in
London is the only one of the kind (so far as I know) in English history;
the Statutes of the realm contain no reference to lepers or leprosy from
first to last; the references in the Rolls of Parliament are to the taxing
of their houses and lands. The laws which deprived lepers of marital
rights and of heirship appear to have been wholly foreign; in England,
leprosy as a bar to succession was made a plea in the law courts. It
appears, however, that a law against lepers was made by a Welsh king in
the tenth century[203]. It is not easy to realize the state of Welsh
society in the tenth century; but we know enough of it in the twelfth
century, from the description of Giraldus Cambrensis, to assert with some
confidence that “leprosy” might have meant anything--perhaps the “lepra
Normannorum[204].”
In Scotland the laws and ordinances, civil and ecclesiastical, against
lepers have been more numerous. In 1242 and 1269, canons of the Scots
Church were made, ordering that lepers should be separated from society in
accordance with general custom. In 1283-84, the statutes of the Society of
Merchants, or the Guildry, of Berwick provided that lepers should not
enter the borough, and that “some gude man sall gather alms for them.” In
1427 the Parliament of Perth authorised ministers and others to search the
parishes for lepers[205].
We conclude, then, that little was made of leprosy by English legislators
(rather more by the Scots), just as we have found that in the endowment of
charities, the leprous had only a small share, and that share a somewhat
exaggerated one owing to the morbid sentimentality of the chivalrous
period. The most liberal estimate of the amount of true leprosy at any
time in England would hardly place it so high as in the worst provinces of
India at the present day. In the province of Burdwan, with a population of
over two millions, which may be taken to have been nearly the population
of England in the thirteenth century, there are enumerated 4604 lepers, or
2·26 in every thousand inhabitants. But even with that excessive
prevalence of leprosy, and with no seclusion of the lepers, a traveller
may visit the province of Burdwan, and not be aware that leprosy is
“frightfully common” in it. In medieval England the village leper may have
been about as common as the village fool; while in the larger towns or
cities, such as London, Norwich, York, Bristol, and Lincoln, true lepers
can hardly have been so numerous as the friars themselves, who are
supposed to have found a large part of their occupation in ministering to
their wants. A rigorous scepticism might be justified, by the absence of
any good diagnostic evidence, in going farther than this. But the
convergence of probabilities does point to a real prevalence of leprosy in
medieval England; and those probabilities will be greatly strengthened by
discovering in the then habits of English living a _vera causa_ for the
disease.
Causes of Medieval Leprosy.
What was there in the medieval manner of life to give rise to a certain
number of cases of leprosy in all the countries of Europe? Granting that
not all who were called _leprosi_ and _leprosae_, were actually the
subjects of _lepra_ as correctly diagnosed, and that the misnomer was not
unlikely to have been applied in the case of princes, nobles and great
ecclesiastics, we have still to reckon with the apparition of leprosy
among the people in medieval Europe and with its gradual extinction, an
extinction that became absolute in most parts of Europe before the Modern
period had begun.
Of the “importation” of leprosy into Britain from some source outside
there can be no serious thought; the words are a meaningless phrase, which
no one with a real knowledge of the conditions, nature and affinities of
leprosy would care to resort to. The varying types of diseases, or their
existence at one time and absence at another, are a reflex of the
variations in the life of the people--in food and drink, wages, domestic
comfort, town life or country life, and the like. No one doubts that the
birth-rate and the death-rate have had great variations from time to time,
depending on the greater or less abundance of the means of subsistence, on
overcrowding, or other things; and the variation in the birth-rate and
death-rate is only the most obvious and numerically precise of a whole
series of variations in vital phenomena, of which the successions,
alternations, and novelties in the types of disease are the least simple,
and least within the reach of mere notional apprehension or mere
statistical management. The apparition and vanishing of leprosy in
medieval Europe was one of those vital phenomena. It may be more easily
apprehended by placing beside it a simple example from our own times.
The pellagra of the North Italian peasantry (and of Roumania, Gascony and
some other limited areas) is the nearest affinity to leprosy among the
species of disease. Strip leprosy of all its superficial and sentimental
characters, analyse its essential phenomena, reduce its pathology to the
most correct outlines, and we shall find it a chronic constitutional
malady not far removed in type from pellagra. In both diseases there are
the early warnings in the excessive sensibility, excessive redness and
changes of colour, at certain spots of skin on or about the face or on the
hands and feet. In both diseases, permanent loss of sensibility follows
the previous exaggeration, blanching of the skin will remain for good at
the spots where redness and discoloration were apt to come and go, and
these affections of the end-regions of nerves will settle, in less
definite way, upon the nervous system at large,--the cerebro-spinal
nervous system, or the organic nervous system, or both together. What
makes leprosy seem a disease in a different class from that, is the
formation of nodules, or lumps, in the regions of affected skin in a
certain proportion of the cases. If leprosy were all anaesthetic leprosy,
its affinities to pellagra would be more quickly perceived; it is because
about one-half of it has more or less of the tuberculated character that a
diversion is created towards another kind of pathology. But the fact that
some cases of leprosy develop nodules along the disordered nerves does not
remove the disease as a whole from the class to which pellagra belongs. In
both diseases we are dealing essentially with a profound disorder of the
nerves and nerve-centres, commencing in local skin-affections which come
and go and at length settle, proceeding to implicate the nervous functions
generally, impairing the efficiency of the individual, and bringing him to
a miserable end. The two diseases diverge each along its own path, leprosy
becoming more a hopeless disorder of the nerves of tissue-nutrition, and
so taking on a structural character mainly but not exclusively, and
pellagra becoming more a hopeless disorder of the organic nervous system
(digestion, circulation, etc.) with implication of the higher nervous
functions, such as the senses, the intellect, and the emotions, and so
taking on a functional character mainly but not exclusively. The
correlation of structure and function is one that goes all through
pathology as well as biology; and here we find it giving character to each
of two chronic disorders of the nervous system, according as the
structural side or the functional side comes uppermost.
What, then, are the circumstances of pellagra, and do these throw light
upon the medieval prevalence of leprosy? Pellagra has been proved with the
highest attainable scientific certainty to be due to a staple diet of
bread or porridge made from damaged or spoilt maize. It followed the
introduction of maize into Lombardy at an interval of two or three
generations, and its distribution corresponds closely to the poorer kinds
of maize on colder soils, and to the class of the peasantry who get the
worst kind of corn or meal for their food. The cases of the disease among
the peasantry of Lombardy and some other maize-growing provinces of
Northern Italy, were about one hundred thousand when last estimated; the
endowed charitable houses and lunatic asylums are full of them. The
connexion of the disease with its causes is perfectly well understood; but
the economic questions of starvation wages, of truck, of large farms with
bailiffs, and of agricultural usage, have proved too much for the chambers
of commerce and the Government; so that there is as yet little or no sign
of the decline of pellagra in the richest provinces of Italy. This disease
is not mentioned in the Bible, therefore it has no traditional vogue; it
is not well suited to knight-errantry, because it is a common evil of
whole provinces; its causes are economic and social, therefore there is no
ready favour to be earned by systematic attempts to deal with them; and
there is absolutely no opening for heroism and self-sacrifice of the more
ostentatious kind. These are among the reasons why this great
object-lesson of a chronic disorder of nutrition, proceeding steadily
before our eyes, has been so little perceived. It is in pellagra, however,
that we find the key to the ancient problem of leprosy. The two diseases
are closely allied in the insidious approach of their symptoms, in their
implicating the tissue-nutrition through the nerves, or the nervous
functions through the nutrition, in their cumulating and incurable
character, and in their transmissibility by inheritance. Thus
nosologically allied, they may be reasonably suspected of having analogous
causes; and as we know the cause of modern pellagra to be something
noxious in the habitual diet of the people, we may look for the cause of
medieval leprosy in something of the same kind.
The dietetic cause is not far to seek, and it cannot be stated better than
in the following well-known passage by the philosophical Gilbert White in
his _Natural History of Selborne_[206]:--
“It must, therefore, in these days be, to a humane and thinking
person, a matter of equal wonder and satisfaction, when he
contemplates how nearly this pest is eradicated, and observes that a
leper is now [1778] a rare sight. He will, moreover, when engaged in
such a train of thought, naturally inquire for the reason. This happy
change perhaps may have originated and been continued from the much
smaller quantity of salted meat and fish now eaten in these kingdoms;
from the use of linen next the skin; from the plenty of bread; and
from the profusion of fruits, roots, legumes, and greens, so common in
every family. Three or four centuries ago, before there were any
enclosures, sown-grasses, field-turnips, or field-carrots, or hay, all
the cattle which had grown fat in summer, and were not killed for
winter use, were turned out soon after Michaelmas to shift as they
could through the dead months; so that no fresh meat could be had in
winter or spring. Hence the marvellous account of vast stores of
salted flesh found in the larder of the eldest Spencer even so late in
the spring as the 3rd of May (600 bacons, 80 carcases of beef, and 600
muttons)[207]. It was from magazines like these that the turbulent
barons supported in idleness their riotous swarms of retainers, ready
for any disorder or mischief. But agriculture is now arrived at such
pitch of perfection, that our best and fattest meats are killed in the
winter; and no man needs eat salted flesh, unless he prefers it, that
has money to buy fresh.
“One cause of this distemper might be no doubt the quantity of
wretched fresh and salt fish consumed by the commonalty at all seasons
as well as in Lent, which our poor now would hardly be persuaded to
touch.... The plenty of good wheaten bread that now is found among all
ranks of people in the south, instead of that miserable sort which
used, in old days, to be made of barley or beans, may contribute not a
little to the sweetening their blood and correcting their juices.”
Let us add to this, that the meat diet of the poorer class, whether serfs
or freemen, would be apt to consist of the more worthless portions, the
semi-putrid pieces in the salted sides of bacon, mutton or beef, and that
badly-cured pork was in many parts the usual kind of flesh-food; and we
shall have no difficulty in finding the noxious element in the diet of the
Middle Ages, which the dietetic hypothesis of leprosy requires. Some who
have advocated that hypothesis for modern leprosy, have laid themselves
open, notwithstanding the ability and industry of their research, to
plausible objections which have no bearing if the hypothesis be
sufficiently safe-guarded. Leprosy, like every other _morbus miseriae_,
needs a number of things working together to produce it, its more or less
uniform specific character or distinctive mark being determined by the
presence of one factor in particular. The special factor should be
generalised as much as possible, so as to cover the whole circumstances of
leprosy: it is not only half-cured or semi-putrid fish[208], but
half-cured or semi-putrid flesh of any kind. The most general expression
for leprosy is a semi-putrid or toxic character of animal food, just as
for the allied pellagra, it is a semi-putrid or toxic character of the
bread or porridge. Moreover it is that noxious or unnatural thing in the
food, not once and again, or as a _bonne bouche_, but somewhat steadily
from day to day as a chief part of the sustenance, and from year to year.
As the rain-drops wear the stones, so the poison in the daily diet tells
upon the constitution. Once more, such special causes may be present in a
country generally, among the poor of all the towns, villages and hamlets,
and yet only one person here and there may show specific effects that are
recognisable as a disease to which we give a name. Unless there be present
the aiding and abetting things, the special factor will hardly make itself
felt; and if there be not the special factor, there may be some other
_morbus miseriae_ but there will not be that one. These aiding things are
for the most part the usual concomitants of poverty and hardships, wearing
out the nerves far more than is commonly supposed and producing in
ordinary an excessive amount of nervous affections among the poor. But
among the poor themselves, as well as among the well-to-do, there are
special susceptibilities in individuals and in families. One person may
have the same unwholesome surroundings as another and the same poisonous
element in his diet, but he may fall into no such train of symptoms as his
leprous neighbour because he is not formed in quite the same way, because
he has “no nerves,” or is of a hardier stock, or because his unwholesome
manner of life comes out in some other form of disease (scrofula perhaps,
less probably gout), or for some other reason deeply hidden in his
ancestry and his personal peculiarities. The chances would be always
largely against that particular combination of factors needed to make
leprosy. It was a _morbus miseriae_ of the Middle Ages, but on the whole
not a very common one; and it was easily shaken off by the national life
when the conditions changed ever so little. It was all the more easily
shaken off by reason of the facilities for divorce, the prohibition of
marriage, and the monastic discipline.
The staple diet as a cause of leprosy was suspected in the Middle Ages,
and by writers as ancient as Galen. It is not without significance that
the minute directions for the dieting of the lepers in the rich hospital
of Sherburn, near Durham, urge special caution as to the freshness of the
fish: when fresh fish was not to be had, red herrings might be
substituted, but only if they were well cured, not putrid nor corrupt.
Those directions were in accordance with the best medical teaching of the
time on the dietetics of leprosy, or on how to prevent leprosy, as it is
given with considerable minuteness in Gordonio and Gilbert[209].
On the other hand we find a singular ordinance of the Scots Parliament at
Scone in 1386, or some forty years after the date of the Durham
regulations: “Gif ony man brings to the market corrupt swine or salmond to
be sauld, they sall be taken by the Bailie and incontinent without ony
question sall be sent to the lepper-folke; and gif there be na
lepper-folke, they sall be destroyed alluterlie[210].” Nothing could be
more significant for the prevalence and persistence of leprosy in
Scotland[211]. Putrid fish and pork did actually come to market; the
dangers of them as regarded the production of leprosy were unsuspected;
and the lepers (genuine or mistaken) were actually directed to be fed with
them. Such food for “lepers” could only have fed the disease; and if it be
the case that genuine leprosy was met with in Edinburgh and Glasgow more
than two centuries after it ceased to be heard of in England, we need be
at no loss to assign the reason why the disease was more inveterate in the
one country than in the other.