Leprosy in the Middle Ages

This post was inspired by a conversation I had with Dr. Christopher Monk in the comments to a post a couple of weeks ago. Sadly, this post doesn’t deal with the issue we discussed.

If you’re like me, everything you know about leprosy comes from the Bible, a Sherlock Holmes short story and the film Ben Hur. None of that prepared me to learn how rampant the disease was in England in the Middle Ages, nor that it was considered to be extremely contagious. This was later discovered not to be the case.

It was due to this belief that lepers were expelled from their homes to live together in leper colonies or, in more urban areas, hospitals, where their movements were restricted. Lepers were known as lazars, after St. Lazarus, the patron saint of lepers. Lazarus was the man covered in sores who begged outside the gate of a rich man in a story told in the Gospel of St. Luke. He is not to be confused with the Lazarus who lived in Bethany and was raised from the dead in the Gospel of St. John, although the confusion was fairly common in the Middle Ages. Leper hospitals were often, unsurprisingly, known as Lazar houses. Lepers were also known as ‘Christ’s special sufferers’.

Although leprosy was declining in Europe in the fourteenth century, this was also the time when people were most hostile towards lepers and they were accused in many countries of conspiring with the Jews to poison wells, thus causing the Black Death.

Leprosy was presumed to be incurable, but doctors came up with treatments to make their patients more comfortable. Leprosy destroys the cell structure of the skin, nerve endings and lymphatic glands. It was difficult to diagnose, though, as the symptoms varied from patient to patient. These included sores (hence the belief that Lazarus was a leper), impaired breathing, loss of sensitivity in nerves and loss of eyebrows. These were also, however, signs of other diseases. Loss of feeling in toes and fingers was generally considered a good indication that someone had leprosy.

As with all medieval illnesses, doctors and patients believed that leprosy was caused by an imbalance in the humours and that different kinds of leprosy were caused by different imbalances. Elephantia was caused by melancholic blood; leonine by choleric blood; tyria (serpent disease) was caused by phlegmatic blood; and alopecia (fox disease) by blood corrupted by something external to the body. Gilbert the Englishman, a thirteenth-century physician, wrote that it was usual for more than one of these imbalances to be involved. Hoarseness was another sign and a recommended form of diagnosis was to ask the patient to sing.

As in most diseases the patient’s urine, blood and pulse could be used to make a diagnosis. With leprosy the hairs were also examined. If they were thin, pale and grey, it could be a sign of leprosy. I suspect that it was less useful as a diagnostic tool with older patients.

Charity and compassion are not modern inventions and many hospitals were established in the twelfth century, both by the wealthy and by monasteries. Among them were hospitals for lepers. They were run by monasteries and convents, and the patients were known as brothers or sisters.

The statutes of a leper hospital in Gloucestershire have survived from the end of the twelfth century and the inhabitants were required to live by a rule similar to that of monks and nuns. Interestingly, like monks, they could be expelled if they did not amend bad behaviour after having been called to account for it for a certain number of times. People in hospitals were expected to attend services in the same way as monks and to pray for the souls of the hospital’s founders and benefactors. Inmates generally wore a grey coat and a scarlet hat, making them very noticeable if they ever left the hospital precincts.

By the beginning of the fourteenth century there were more leper houses than there were hospitals for the sick in England. It was at this point, however, that leprosy began to decline.

You may be wondering what the photograph at the top of the post has to do with leprosy. I took it from the presumed site of the lazar hospital in Southampton looking back to the town’s main gate to illustrate how far away it was from the town. You can’t even see the gate in my photograph, as it’s about half a mile away. In the fourteenth century what you would have seen was partly common land and partly fields. You would also have seen two windmills. It was on the road north to both Winchester and London, so there would have been many opportunities for travellers to bestow their charity on the hospital’s inhabitants, which they did. As an aside, don’t worry about my safety/sanity as I took the photograph. It was just after seven on a Sunday morning and I was standing in the middle of a zebra crossing, having looked both ways before stepping into the road.

The leper hospital in Southampton, St Mary Magdalene (a common dedication for lazar houses), was set up by 1173. It was given its own lands by its founders, wealthy merchants in the town. As well as gifts from travellers, it was financed by revenues from these lands, legacies and a duty of a penny on each tun of wine imported into the town, a major wine importer. A tun was a little short of 1,000 litres. The area where the hospital was situated became known as Marlands. The patients would have grown vegetables, fruit and plants for medicines.

The hospital was on both sides of the road to the north and I wonder whether one side of the road housed women and the other men, or whether the patients were on one side and the staff on the other.

Lepers essentially left the world of the living to go into a lazar house. They went through a ritual burial, kneeling under a black pall, such as would be put over a coffin, while a mass was said over them. At the end their feet were covered with earth. Everyone knew that they would never return to their homes and families.

Sources:
A Dictionary of Medieval Terms and Phrases by Christopher Corédon and Ann Williams
Medieval Medicine by Faith Wallis
Medieval Southampton by Colin Platt
A Social History of England 1200 – 1500 ed Rosemary Horrox and W. Mark Ormrod
The Scourging Angel by Benedict Gummer
The Companion to Cathedrals and Abbeys by Stephen Friar

April Munday is the author of the Soldiers of Fortune and Regency Spies series of novels, as well as standalone novels set in the fourteenth century.

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