Chapter II: Leprosy in Medieval Britain (1)

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].