Everyday Life

Lepers Life: Medieval Attitudes Towards Leprosy

Lepers are individuals affected by leprosy, a chronic infectious disease caused by the bacteria Mycobacterium leprae or Mycobacterium lepromatosis. Historically, leprosy was feared and misunderstood, leading to significant social stigma.

This stigma often resulted in the segregation of affected individuals into leper colonies or their complete ostracisation from society. Today we know it as Hansen’s disease.

Leprosy, one of the oldest and most feared infectious diseases known to man. It has been the scourge of society since ancient times. Unforgiving and indiscriminate, it leaves the infected ostracised, shunned and doomed to live a lonely life on the periphery of society until their untimely death. Or does it?

Contents

What do we actually know about the origins of this disease? How did medieval Society really respond to those infected? And if leprosy was a punishment from God, how did the Church respond to those afflicted?

What is it, Where Did it Come From?

There has been substantial debate as to whether leprosy originated in ancient Eastern Africa or India; it is difficult to say with any degree of certainty.

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However, bones dated to 2000 BC with markings which appear consistent in those with leprosy have been discovered in India. Scientific studies of osteo-archaeological remains have also helped build up a picture of the spread of the disease.

Skeletons unearthed from a leprosy hospital in Odense, Denmark, show that even 700 years post-burial, traces of leprosy bacteria are still detectable in the ancient bones. (Photo credit: Dorthe Pedersen)

It is believed to have followed the routes of migration of early human groups from East Africa towards Asia, establishing itself in Europe and the Mediterranean around 40,000 years ago. It is therefore reasonable to believe that leprosy plagued even the Neanderthal and the first homo-sapien groups.

The name Leprosy comes from the Greek word lepros meaning ‘scaly’. Now known as Hansen’s disease, after the Norwegian physician, Gerhard Armauer Hansen who identified the bacteria responsible living in the skin lesions of sufferers in 1874.

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Modern medicine knows it to be an infectious chronic disease caused by a bacteria named, Mycobacterium leprae. Primarily affecting the nerves and skin, it is contagious but not as easy to catch as you might believe!

Shaking Hands

Leprosy (Hansen’s disease) is transmitted through droplets from the nose and mouth. Catching the disease requires close contact with an infected person over a period of time. It is not spread through infrequent or casual contact. You cannot catch it from shaking hands, hugging or sitting next to a person with the disease for example.

However, for those unfortunate enough to contract the disease, if left untreated the nerve damage would result in crippling of the hands and feet and eventual paralysis, respiratory difficulties and blindness. It would be understandable for our Medieval counterparts to fear such a disease.

Leprosy Within the Medieval Community

It has become ingrained in the modern mindset that leprosy was a feared disease and that those who were infected became social outcasts, homeless and forced to wander the fields and forests of England, ringing bells to forewarn of their approach. Either that or they were sent to ‘leper colonies’, expected to live apart from the rest of society and subjected to strict rules.  

The hospital of the leper colony, along with much of Dunwich, has succumbed to the sea, yet remnants of the leper chapel endure – it stands as one of the few remaining in the country. Historically, this chapel was connected to the leper hospital, originating from the 12th century when Dunwich thrived as a bustling port. Given the extensive maritime connections to regions affected by leprosy, it was inevitable that cases would surface in Dunwich.

Fast forward a few centuries and in 1897 an international conference was held in Berlin to review the leprosy situation in Europe. From this conference arose the misconception that the disease was highly infectious and easily spread from person to person.

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A system of mass segregation was proposed. It is possible that the stereotype of the attitude and treatment of leprosy sufferers during Medieval times was actually a Victorian invention and one which has prevailed. 

Norman Conquest

Some historians have attempted to dispel this myth by looking at how Medieval society actually delt with the leprosy problem. Professor Carole Rawcliffe, suggests that lepers were not treated as social outcasts as we have been led to believe.

She points out that during the period just after the Norman Conquest and the year 1350, around 300 hospitals were established across England in order to provide treatment for those suffering from a disease, then known as Lepra. These hospitals were known as Leprosaria.

Leprosaria and Queen Matilda

The first known Leprosaria was established in 1101 by none other than Queen Matilda, wife of King Henry I. Located on a site now occupied by St Giles-in-the-Fields Church. It was dedicated to St Giles – the Patron Saint of outcasts. The hospital itself had 8 acres of farmland attached and had its own chapel.

The church, dedicated to St Giles the Hermit, originated as the chapel for a 12th-century monastery and leper hospital, situated in the countryside between Westminster and the City of London.
The church, dedicated to St Giles the Hermit, originated as the chapel for a 12th-century monastery and leper hospital, situated in the countryside between Westminster and the City of London.

Queen Matilda was a great philanthropist and dedicated funds to multiple charitable causes. She not only channelled funds into the St Giles Leprosaria but also had two more built, one at Chichester and the other at Westminster. Her lead was followed by the church who set up their own hospitals and later by co-operatives of wealthy citizens, eager to make a name for themselves.

Leper Hospitals

The existence of the Leprosy hospital at St Giles and many others besides highlights that almost a third of all English hospitals were intended for the treatment and care of lepers. There were many of these small hospitals established in London where the population was most concentrated.

What’s this? Leper hospitals in London itself? Surely not! These cannot be the lepers of old who were feared and shunned by all society. Almost all records of these hospitals are now lost so it is impossible to guess at the numbers of patients that passed through their care. 

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Painting from the late fifteenth century depicting a leper using a rattle or bell to signal his arrival.
Painting from the late fifteenth century depicting a leper using a rattle or bell to signal his arrival.

Among the records that do survive we can identify that there were 7 or so main leprosaria hospitals and each one lay just outside the city gates on a major approach road into / out of London. The same is true of many other large towns and cities such as Norwich, where again, records show these hospitals were positioned literally just outside the city gates.

Why Were They so Close to the Cities and Towns?

Christ himself is often pictured in medieval church manuscripts touching and healing leprosy sufferers. But beyond this he is occasionally pictured as a leper himself, covered in spots.

These are images that the people of Medieval Europe would have been familiar with and sermons discussing Christ’s actions in caring for these poor people and comparing their suffering to his own on the cross would undoubtedly have been given.

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One anecdote recalls a period during Lent one year during her reign when Queen Matilda was visited by her brother David. David was horrified to find his sister in her apartments at Westminster surrounded by leprosy sufferers. David reported that his sister began to not only wa

Site of medieval leper hospital, Burton Lazars
Site of medieval leper hospital, Burton Lazars

Disgusted, he challenged her by querying whether the King would want to kiss his wife’s lips if he knew they had been kissing decayed, leprosy riddled feet.
Her reply? “Jesus did it so why shouldn’t I?” Or words to that effect.

God Himself

If Jesus Christ himself is willing to touch and care for the victims of leprosy then how can the god-fearing churchgoer not follow his example and offer charity and care to those in need?

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Some manuscripts even hint at the suggestion that leprosy is a curse bestowed by God himself and because the leprosy victim would have suffered such torment from the disease in life, having leprosy was actually a shortcut to heaven and God, allowing the afflicted to bypass purgatory! 

Bearing these attitudes in mind it is no coincidence that leprosaria can be found outside the entrance gates to a town, frequently with a chapel and alms box attached. Travelling during Medieval times was a risky business.

Potholed roads, swathes of open land and dense forest populated with wild boar, wolves, and not to mention the risk of being set upon by bandits and criminals.

If you were to embark upon a journey it is likely you would want to say a prayer before you go or even better, have others say prayers for you also.

Popping into a leper hospital, dropping some coins into the alms box and entering your name into the prayer leger would give you some added security that the lepers within would be compelled to say prayers for a safe journey. Indeed, you might also pop in on your way back into town also, to give thanks to God for your safe return.

The Leper King

Another example of wider Medieval attitudes towards leprosy can be observed in the truly remarkable case of Baldwin IV of Jerusalem.

Baldwin contracted leprosy during his childhood. Though he fought against the early warning signs of loss of sensation in his right arm, ultimately he was to suffer its full effects from 1183 until his early death, aged just 19 in 1185.

Site of medieval leper hospital, Burton Lazars
Site of medieval leper hospital, Burton Lazars

Yet despite his obvious disfigurement and disability he remained a respected and effective King until his death. Not all societies at this time were accepting of those with the disease.

The Arab and Jewish communities had long since shunned leprosy sufferers and did indeed enforce their segregation from society. They were surprised by the existence of such a man as Baldwin, and a King no less! 

Kings in Christendom

This view is expressed in the writings of Imad ad-Din al Isfahani (close confidant of Saladin), “In spite of illness the Franks were loyal to him, they gave him every encouragement…being satisfied to have him as their ruler; they exalted him…they were anxious to keep him in office, but they paid no attention to his leprosy.”

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One personage of note who does prop up the later Victorian theory, is long serving Pope, Alexander III. He wrote in a letter to all the Kings in Christendom about the difficulties being faced by the Kingdom of Jerusalem, “…there is no king who can rule that land, since the one who governs the kingdom, namely Baldwin, is so gravely scourged by the judgement of God, as we are sure that he can hardly tolerate the continuous tortures of his body.”

The troubling words here are, ‘the scourge of God’s Judgement’. Did the Pope mean that the King was cursed in some way and deserved to be deposed or is it just a general statement about the advanced stage of his leprosy making it difficult for him to continue to govern?

The former seems at odds with the kindly treatment of Lepers elsewhere in Europe. At the time this letter was written, Baldwin had lost his sight and was unable to walk or use either of his hands.

Leprosy Asylums 

Contrary to widespread belief, leprosy sufferers were not universally confined to asylums during the Middle Ages. In Europe, these asylums were refuges for various individuals, some of whom had skin conditions that included leprosy. The rise of asylums in England from 1100 to 1250 did not strictly correlate with a significant leprosy outbreak.

Furthermore, the decline of leprosy in Europe post-medieval period wasn’t solely due to the mass institutionalization in leprosy asylums.

Medieval leper bell
Medieval leper bell. The bell was used by lepers to signal their approach, warning healthy individuals to keep their distance.

For instance, Portugal recorded 466 leprosy cases in 1898, and by 1938, the numbers justified establishing Rovisco Pais, a facility for leprosy patients. This institution catered to both returnees from the New World and local rural populations in Portugal.

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Similarly, Spain’s attention to leprosy was significant, with the Patronato San Francisco de Borja, Fontilles, founded in 1902, treating substantial cases. Historical records and genetic research indicate the disease’s transmission via trade and slavery routes linking Africa, Spain, Portugal, and the West Indies.

Leprosy Sufferers

In the Middle Ages, Europe saw the establishment of numerous leprosaria, with estimates of 19,000 at one point. These institutions varied greatly in structure and operational rules, often providing basic care not only for leprosy sufferers but also for the destitute.

A bishop instructing clerics with leprosy from Omne Bonum by 14th-century clerk James le Palmer. Medieval depictions of leprosy commonly showed the patient to have red spots

The English leprosaria, for example, operated on monastic principles, enforcing vows upon the inmates, who could be expelled for non-compliance. The condition of leprosy held deep symbolic meaning within the Christian ethos, with societal withdrawal seen as a form of spiritual purification.

The Order of Saint Lazarus, originating as a leper hospital in Jerusalem, maintained a strong association with leprosy care, initially composed of leper knights.

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Historical figures, like Radegund, are celebrated for their compassionate care towards lepers, embodying the era’s mingled fear and reverence towards the disease. Lepers often carried clappers or bells, partly to seek alms and partly to signal their presence.

Medieval leprosaria were multifunctional, offering a sanctuary for those afflicted, alleviating public fear, and contributing to social stability by segregating and providing for this marginalized group.

Or Was it all Just a Big Misunderstanding?

Scholars have also put forward another theory regarding the Medieval attitude to leprosy. Sometimes a leper may not have actually had leprosy at all. Lepers were not prevented from visiting shrines or markets and the leprosaria were not prisons, people could come and go. So if this was a feared, contagious disease how was such activity permitted?

Leper Strips near Great Torrington, Devon. The two leper strips are remnants of a medieval strip field system. They were part of the land held by the Leper Hospital in Taddiport (just to the right of the picture). 150 years ago seven of these strips still existed, now these last two have been preserved.
Leper Strips near Great Torrington, Devon. The two leper strips are remnants of a medieval strip field system. They were part of the land held by the Leper Hospital in Taddiport (just to the right of the picture). 150 years ago seven of these strips still existed, now these last two have been preserved.

The culprit in this instance is one word from the Hebrew version of the bible, “tzara’ath”. This has no direct translation for one medical condition but rather encompasses a whole variety of dermatological ailments such as psoriasis, scabies, eczema and probably even dandruff.

Lepra or Leprosy?

Matters were made more confusing as the next translation was into Greek where tzara’ath became “lepra”. It is quite possible therefore that in the medieval world, Lepra or Leprosy was also a term used for multiple skin conditions, not just Hansen’s disease (the leprosy of today).

G. H. A. Hansen, discoverer of M. leprae
G. H. A. Hansen, discoverer of M. leprae

And no doubt, before the advent of antibiotics there must have been many skin flareups which would account for the significant number of leprosaria in England during the Medieval period.

Not only that but in an age of modest dress where most of the body was kept covered excepting the hands and face, facial skin conditions may well have been a point of focus, not easily disguised. It was only once you looked truly terrible that you were expected to live apart and this was a decision made by yourself and by your family.

Leprosy and Lepers Today

Genuine leprosy, such as that experienced by King Baldwin is a curable disease and if multi-drug therapy is employed early on there is unlikely to be any lasting disability. It is still around in about 120 countries and despite the availability of treatment there are around 200,000 new cases reported each year according to the World Health Organisation.

Distribution of leprosy around the world in 1891
Distribution of leprosy around the world in 1891

Today, leprosy is often referred to by its medical name, Hansen’s disease, named after Dr. Gerhard Armauer Hansen of Norway, who identified the causative agent, Mycobacterium leprae, in 1873. This term is used to help reduce the stigma historically associated with the word “leprosy,” which carries connotations of social exclusion and isolation due to long-standing misunderstandings of the disease. Hansen’s disease is recognized as a curable infection with effective treatments available, leading to a significant decrease in its prevalence worldwide.

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