A Stigmatized Disease: How Interpretation Impacted Leprosy Patients in the Medieval World

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Leprosy in Medieval Europe was a heavy burden to bear for those suffering from the disease. Even though scientists have a better understanding of what causes leprosy, it is still stigmatized in areas of the world today. In Medieval Europe, the official cause for Leprosy was unknown, partially due to the fact that microscopes would not be invented until the end of the 16th century. There were two widely accepted causes for the disease, and which one was believed seemed to influence the way the infected individual was ultimately treated. The first explanation was that Leprosy was the “disease of the soul,” and that it served as an exterior punishment for some kind of mortal sin (Miller 3). As one can guess, not only were lepers separated from society because healthy community members feared contagion, but also because they believed that the person was morally corrupt. On the other hand, some argued that the disease was given by God to people on earth as a trial and that they would live beside God in heaven in the afterlife as a reward for overcoming the difficult challenges that they were given during life. This perspective allowed the patients to be cared and sympathized for and they were often seen as being avenues to the salvation of others. Not only did the experiences of lepers differ with regards to how their disease was perceived to have originated, but the level of one’s wealth also tended to affect their experiences. It is commonly believed that as leprosy grew in prevalence in Britain and other European countries post 1066 that the general treatment of the infected worsened as time went on (Manchester 3). This chronology is not completely true though and there were instances where lepers were not treated progressively worse, even after the rapid spread of the disease caused it to hold more weight socially. Overall, this essay will explore how leprosy was perceived to have originated during various times and the effect that the interpretation ultimately had on the sick.  

Before discussing how people with leprosy were treated, it is important to first look at what leprosy is and what it does to the human body in order to have a better understanding of the stigma surrounding it. The word leprosy comes from the Greek word, Lepra, which means scale, like that found on snakes, and lepra was originally used to identify a wide variety of skin diseases (Miller 17). Another term that was popular until about 1453 was Elephantiasis or Elephant Disease (Miller 17). Leprosy is caused by the bacterium Mycobacterium leprae which has a close connection to Tuberculosis (Grange 30).  Skeletal remains have revealed to researchers that the strains of leprosy that were prevalent in the middle ages are actually identical to the strains that exist today (Lewis). The disease can come forward in many forms, but the most commonly feared form in Medieval Europe involved damage to one’s vocal cords, a loss of sensation, lesions, and the deterioration of nerves and muscles that cause limbs to dry off (Stoham-Steiner, 23). It was not until 1873 that a Norwegian scientist, Gerhard Armauer Hansen, identified Mycobacterium leprae as the cause for leprosy, and since then, leprosy has been renamed Hansen’s Disease (Miller 7). Mycobacterium leprae cannot be grown in vitro, meaning that it cannot be reproduced in a lab, thus making the development of vaccinations for leprosy seem nearly impossible. The BCG vaccine for Tuberculosis can serve as a preventative in some instances, but chemotherapy and drug smoothies are the most common way of treating patients today (Grange 64, 97).  

During Galen’s lifetime, he believed that leprosy was caused by a buildup of black bile in the body, and his contemporary, Aretaios wrote in, On Acute and Chronic Diseases, about the disease being contagious (Miller 7, 14). Professional physicians tended to agree that the disease could spread quickly from those who were infected to healthy individuals, thus resulting in the idea that lepers needed to be seperated from society (Miller 52).Although not everyone with leprosy faces disfigurement, the few that do are so dramatic in appearance that it set the standard that leprosy equals severe disfigurement (Corrigan 42). Leprosy is surely not the only stigmatized disease to ever have existed, but it had an interesting and disheartening past in the medieval world. 

For a long time, the Byzantine Empire was known for treating lepers with compassion, unlike most instances, but not all, in European countries who established laws for self-protection, not kindness (Weymouth 88).  The reason for this is partially due to the fact that many Byzantine Christians believed that leprosy was sent by God as a test to see how both the affected and healthy would act (Miller 41). Shortly after Emperor Constantine founded the capital of the Byzantine empire, people began contracting the disease left and right seemingly with little explanation (Miller 27). By 398, a popular bishop in Constantinople funded the construction of an asylum for the purposes of caring for lepers just outside of the city (Miller 30). Saints would make a spectacle of themselves by kissing leper patients, beginning in the 4th century, in order to show the unrelenting love that Christ showed to everyone on earth (Miller 44). Saint Francis of Assisi, who lived during the 4th century, was known to have been terrified of lepers, but he kissed one in order to face his fear, as well as to live closer to the lifestyle that Jesus led. In fact, there are many instances where leprosy is brought up in the bible, but one story in particular talks about Jesus saving ten infected lepers by instructing them to go seek relief from the local priests. Once cured, only one of the nine healed lepers returns to throw himself at Jesus’s feet in gratitude (Luke 17: 12-19). Jesus tells the man, a foreigner, to rise up and leave because his faith helped to make him well again (Luke 17:12-19). This story illustrates that not all of those afflicted with leprosy were bad or faithless people. 

Gregory of Nyssa and Gregory of Nazianzos urged Christians to assist leper victims and special institutions for the care of lepers were established in Byzantine society as well as elsewhere, and were supplied with everything necessary to properly care for the patients from the church and from private benefactors (Miller 68, 129). Saint Gregory of Nazianzus (c. 325-390) wrote, “We should above all be especially pitiful toward those afflicted with the Sacred Malady, who are gangrenous and rotten of flesh, even to their bones and to the marrow of their bones” (Brody 101). Most of the time, priests were actually the ones who diagnosed lepers and by 1427, most church officials were required by law in many European countries to report instances of sickness to the kings (Weymouth 88). From the 11th to the 13th century, there was a steady increase in the number of leper hospitals operating in Europe, suggesting that the disease was becoming more and more common as time went on (Manchester 5).

One example of leprosy being interpreted as a holy disease from God followed the return of the soldiers from the First Crusade, and this example also represents a break in the general chronology of treatment, meaning that by the time leprosy had spread throughout Europe after 1066, harsh treatment for lepers was not universally true in all instances. Many of the men had contracted leprosy while away fighting in the religious wars, but they did not want to believe it was the result of some terrible sin (Brody 103). Instead, they interpreted the disease as a sign of God’s affection, believing that the men were up to be challenged on earth during their lifetimes because they were the chosen ones (Brody 103). Clement IV made an order stating that, “…all prelates of the church, under pain of excommunication, are to give their help to the Knights of Lazarus” (Weymouth 102). It is clear how important assisting lepers were at times, so much so that Cement IV’s threat to excommunicate people, meaning send them to hell, was resting on whether or not they treated the crusaders with leprosy with generosity and kindness. In fact, there were cases where sinners were ordered to give money to leper hospitals as an act of propitiation for their crime (Weymouth 104). In instances such as these, it is obvious that the care for leper patients could be used as a means of establishing a personal relationship with God. 

Cistercian abbot, Aelred of Rievaulx (c. 1167) declared that the human body acts as a receptacle for the soul. He goes on to state that, “Just as food that is good could be served in an ugly dish, a bad soul could have a nice outward appearance” (Rawcliff 55). Hearing this concept, Louis IV of France asked his good friend, Jean Joinville whether or not he would rather commit a mortal sin or have leprosy to which Jean answered that he would commit sinful acts 30x over to avoid disfigurement (Rawcliff 55). This was not the answer that Louis IV was looking for though, for he spent a lot of his personal life in leprosariums feeding and caring for the poor and admiring them for their strength (Rawcliff 55). 

 Going further with the idea of chronology and the general treatment of leprosy patients, it is important to note that the separation of people who contracted leprosy was not as clearly defined as one would think, meaning that not all cases of isolation were extreme. For instance, not all leprosariums were segregated far away from cities and many of these institutions were not self-sufficient, therefore depending on a connection to a city-center for survival (Rawcliff 260).  Also, in many of these hospitals, the sick were expected to be buried in separate plots from the un-afflicted, but this was not always the case. Families were often able to obtain the bodies of relatives who had leprosy and bury them in plots with the rest of the family, as Carole Rawcliff points out in, Leprosy in Medieval England (Rawcliff 261). Also, laws were altered to allow lepers to beg for alms as a means of supplementing their incomes. They were often allowed to beg outside of the hospital doors, at the gates exiting the city, and in markets on non-market days (Weymouth 93). Finally, not all people who lived with leprosy were treated cruelly. One archaeological find that illustrates this involves the skeletal remains of a young woman between 18 and 24 found in an early medieval cemetery in present-day Cambridgeshire (Fleming 346). Her skull and lower legs show damage caused by leprosy, which historians believe she contracted during her early teenage years (Fleming 347).Despite her apparent disfigurement, her grave goods are quite impressive and consist of expensive jewelry, an oak bucket, a fossilized sea urchin, a sheep’s knuckle, and a full bed (Fleming 346-347). Even though this young lady suffered from leprosy, her burial was handled with a great deal of care and respect and she shows no sign of having lived a pariah’s life, which therefore illustrates that not everyone with leprosy was treated poorly in life. There is little to no explanation whether or not this woman was treated well as a leper because of her family’s financial standing, or whether or not her disease was interpreted as a challenge from the lord. Regardless, religious interpretation, reputation, and money were all factors that affected how a person suffering from leprosy was treated, and leprosy did not always guarantee an isolated life full of abuse and misunderstanding.

Now that we have discussed how leprosy was interpreted in a positive light, let us look at the consequences of seeing leprosy as resulting from sin and moral corruption. Many laymen, physicians, and religious figureheads believed that leprosy came on when a spiritual deformity left its traces on the physical body, thus enabling people to spot a corrupted person (Rawcliff 49). Some physicians, like Platearius, still looked at the medical texts of the ancients and believed that the environment did have an affect on one’s health, therefore concluding that leprosy could occur from the ingestion of melancholic food, corrupt air, contact with a leper, bad semen, sex with a leper, or conception during menstruation (Platearius 202). Conclusions about sexual corruption was commonplace when it came to lepers, Jews, suspected witches, and damaging the reputation of a powerful woman. It was sometimes believed that a child born with leprosy was being punished for their parent’s inability to control their sexual urges, and attributing sexual profligacy to lepers made them seem dangerous to the general public (Stoham-Steiner 36). In the 14th century, pregnant women with leprosy were buried alive in order to remove her and the offspring of her sin from society (Weymouth 92). Some groups of leper victims in the Middle Ages were known to have been so bitter by the cards they were dealt that they would conjugate around brothels and infect healthy individuals in order to add to their numbers (“The Control of Leprosy 570”). Although that behavior certainly was not subscribed to by all leper patients, the stories of the times that those actions did take place further injured the reputation that lepers held in the public’s eye. Henri de Mondeville, a French surgeon who practiced at the end of the 13th and beginning of the 14th century compared leprosy to cancer, stating that the person was tainted by an irreversible corruption (Rawcliff). He goes on to say that just as the cancerous member must be cut away from the body to cure the patient, leprosy cannot be cured without removing all of the corruption, which is an impossible task (Rawcliff). Interpreting leprosy as being a form of punishment for negative behavior left these individuals as being widely feared and hated, and in many cases, forced to live out their lives almost as a separate and lower class.

The fear of contagion as well as the hatred for the infected led to a lot of mistreatment of the sick. Harsh laws, such as one’s about divorce and separation, were often seen as being enacted for the purposes of preventive medicine, but some laws were cruel and unjustified (Weymouth 91). Whenever possible, leprosariums were constructed downwind, so that the residents in the city did not have to be exposed to the air after it went past the asylums (Brody 74). The widely accepted miasmas theory stated that disease was spread through smell, therefore, the stench of the leper’s infected skin provoked unrest (Rawcliff 275). Edward III created an edict in 1346 that ordered for the removal of all lepers from the city of London. His edict read as such:

 

‘Edward, by the grace of God, etc. Forasmuch as we have been given to understand 

that many persons, as well of the city aforesaid as others coming to the said city, being

smitten with the blemish of leprosy, do publically dwell among the other citizens and

sound persons, and there continually abide and do not hesitate to communicate with 

them, as well in public places as in private; and that some of them, endeavouring to

contaminate others with that abominable blemish (that so, to their own wretched solace,

they may have the more fellows in suffering) as well in the way of mutual 

communications and by the contagion of their polluted breath, 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 of the people

dwelling in the city aforesaid, and the manifest of peril of other persons to the same city

Restoring” (Weymouth 87-88).

 

Edward sincerely believed that he was protecting the people of the city through this decree. During the 14th century it was common to burn the clothes of lepers in order to destroy the miasmas, and in the 15th century, many almshouses were known to throw lepers out because of the risk that they posed to the public’s health (Rawcliff 275-277). Lepers on the streets were even spit on by passersby either as an act of hate or as a way of reminding the individual about the sin they must have committed (Stoham-Steiner 62). Sometimes cruelty towards lepers was seen as an act of religion in practice since they were outwardly being punished by God in the eyes of the people (Weymouth 107). 

People with leprosy were often seen as beggars on the streets, therefore reinforcing another negative association that leprosy is directly related to poverty (Corrigan 143). In medieval law codes, lepers were considered to be dead once they were diagnosed. This meant that they were not allowed to inherit, give gifts, sue, or enter into contracts (Brody 83). In 643, Rothar-the Lombard King declared, “If anyone becomes a leper, and this becomes known to a judge or a matter of general repute to the people, and he is expelled from the city or dwelling, so that he lives alone, let him not be permitted to give or donate his possessions to anyone at all, because on the very day when he is expelled, he is considered as dead. Nevertheless, as long as he lives let him be supported from the possessions he leaves, for good will” (Brody 80-81). As Rothar stated, there were instances where lepers were allowed to keep their belongings, but sometimes the government took claim of the person’s house or the leprosariums required the donation of all worldly possessions as a means of payment for their services (Brody 83). William of Newmarch, a leper living during King John’s reign in England, faced the difficulties of having his possessions taken by the court, rather than given to his family (Weymouth 92). The order the local sheriff received about William stated the following:

 

‘The King to the Sheriff of Somerset, greeting: We command you to give

Geoffrey de St. Martin seizing of the lands which belonged to William of

Newmarch in your bailiwick. For we have committed him the custody thereof,

so that he answer for them to us at our exchequer; and if he (William of Newmarch) 

have given away any of his lands after he fell sick with leprosy, cause the same to

be restored to his Barony’ (Weymouth 92). 

 

Not only did lepers face discrimination and segregation, but there have also been instances in history where they were brutally murdered. One of the most dramatic cases of public execution occurred in June of 1321 by King Philip V in Southern France. A rumor had spread that a group of lepers were plotting to poison the wells, resulting in Philip V making a public announcement regarding the plot, and people reacted with violence (Miller 96). Lepers in the city were rounded up and burned to death without a trial, but on August 16, 1321, the remaining lepers were sent to live in asylums after being pardoned by the King, leading experts to conclude that the leper plot was simply a hoax (Miller 97). Henry II of England and then his great-grandson, Edward I also had a fear of lepers and believed them to be dangerous. Henry II was known to have strapped lepers to posts and burned them while some were buried alive (Brody 69). 

There is no clear explanation of what caused leprosy to decrease after the 14th century. One reason why historians think that the 14th century marks the beginning of the decline is due to the fact that by the 14th century the number of leper hospitals in Europe begins to steadily decrease, thus suggesting that less people were being affected by that time (Manchester 5). It is reasonable to estimate that a combination of increased standards of living and hygienic practices, a widespread death of the most susceptible people, and a cross-reactive protective immunity built up from parallel increases in tuberculosis during medieval times could have all led to a decrease in the number of people with leprosy (Bennett). The mistreatment of people with leprosy is not restrained to just the medieval world though. In fact, in the colonial pacific, a leper colony was founded on the island of Molokai, where the disease was referred to as “mai ho’okawale” or “ the separating sickness” (Edmond 147). In areas of the world where Buddhism or Hinduism are widely practiced such as in India and Nepal, there is still an overwhelming idea that leprosy serves as a sort of karma for a sin or injustice in a previous life (Corrigan 142). Although leprosy is a lot more rare today, there are still parts of the world where it exists. Perhaps knowing more about the history of how this disease has been stigmatized can help prevent future mistreatment of patients. The way that people with leprosy were treated in Medieval Europe depended highly around how the disease was thought to have been contracted. In some cases, leprosy was believed to be a challenge sent by God who would then reward the sufferer after death. These people were looked at in a sympathetic light and often served as an opportunity for healthy people to get closer to God through their acts of compassion. On the other hand, leprosy was typically seen as being a punishment for sinful behavior, leading to hatred, fear, and the belief that these people were inherently dangerous to be around. By analyzing the consequences of these varying interpretations and by questioning the clearly defined chronology of treatment, scholars have the ability to better understand how leper patients were treated and why their lives may have looked the way that they did. Medieval leprosy can serve as a lens to the study of medical practice and institutional care, religious interpretation, stigmatization, and fear.

Until Next Time

N.F.

Sources:

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  • Brody, Saul Nathaniel. The Disease of the soul: Leprosy in Medieval Literature. Cornell University Press: New York, 1974. 
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  • Luke 17: 12-19. BibleGateway. Accessed 7 February, 2020.https://www. biblegateway.com/passage/?search=Luke+17%3A12-19&version=NIV
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