Chapter II: Leprosy in Medieval Britain (2)

To these samples, which are also the chief instances of English leper-hospitals, may be added two or three more to bring out another side of the matter. In the cases already given, it has been seen that the provision for the clerical staff was either a very liberal one at first or became so in course of time. The hospitals, whether leprous or other, were for the most part dependencies of the abbeys, affording occupation and residence to so many more monks, just as if they had been “cells” of the abbey. The enormous disproportion of the clerical staff to the inmates of hospitals (not, however, leprous) is seen in the instances of St Giles’s at Norwich, St Saviour’s at Bury and St Cross at Winchester. The provision was about six for the poor and half-a-dozen for the monks. But even the purely nosocomial part of these charities was in not a few instances for the immediate relief of the monasteries themselves. St Bartholomew’s at Chatham, one of the earliest foundations usually counted among the leper-hospitals, was for sick or infirm monks. The hospital at Basingstoke, endowed by Merton College, Oxford, was for incurably sick fellows and scholars of Merton itself. The leper-hospital at Ilford in Essex was founded about 1180 by the rich abbey of Barking, for the leprous tenants and servants of the abbey, the provision being for a secular master, a leprous master, thirteen leprous brethren, two chaplains and a clerk. St Lawrence’s at Canterbury (1137) was for leprous monks or for the poor parents and relations of monks. St Peter’s at Bury St Edmunds, founded by abbot Anselm in the reign of Henry I., was for priests and others when they grew old, infirm, leprous, or diseased.

The instances which have been detailed in the last few pages, perhaps not without risk of tediousness, have not been chosen to give a colour to the view of medieval leprosy; they are a fair sample of the whole, and they include nearly all those leper-hospitals of which the charters or other authentic records are known[185]. It is possible by using every verbal reference to leprosy that may be found in connexion with all the five hundred or more medieval English hospitals in Bishop Tanner’s _Notitia Monastica_ or in Dugdale’s _Monasticon_, to make out a list of over a hundred leper-hospitals of one kind or another. But there are probably not thirty of them for which the special destination of the charity is known from charters or inquisitions; and even these, as we have seen, were not all purely for lepers or even mainly for lepers. As to the rest of the list of one hundred, the connexion with leprosy is of the vaguest kind. Thus, four out of the five hospitals in Cornwall are called lazar-houses or leper-hospitals, but they were so called merely on the authority of antiquaries subsequent to the sixteenth century. The same criticism applies almost equally to the eight so-called leper-hospitals, out of a total of fourteen medieval hospitals of all kinds, in Devonshire. It is clear that “lazar-house” became an even more widely generic term than the terms _lepra_ and _leprosus_ themselves[186].

Thus our doubts as to the amount of true leprosy that once existed in England, and was provided for in the access of chivalrous sentiment that came upon Christendom in the twelfth and thirteenth centuries, tend to multiply in a compound ratio. We doubt whether many of the so-called leper-houses or lazar-houses in the list of one hundred, more or less, that may be compiled from the _Monasticon_, were not ordinary refuges for the sick and infirm poor, like the three or four hundred other religious charities of the country. We know that, in some instances of leper-hospitals with authentic charters, the provision for the leprous was in the proportion of one to three or four of non-leprous inmates. We know that as early as the end of the thirteenth century the _leprosi_ were disappearing or getting displaced even from hospitals where the intentions of the founder were explicit. And lastly we doubt the homogeneity of the disease called _lepra_ and of the class called _leprosi_.

As to the foundations of a later age they were no longer under ecclesiastical management, and they seem to have been mostly rude shelters on the outskirts of the larger towns. In 1316 a burgess of Rochester, who had sat in Parliament, left a house in Eastgate to be called St Katharine’s Spital, “for poor men of the city, leprous or otherwise diseased, impotent and poor”--or, in other words, a common almshouse. The remarkable ordinance of Edward III. in 1346, for the expulsion of lepers from London, seems to have been the occasion of the founding of two so-called lazar-houses, one in Kent Street, Southwark, called “the Loke[187],” and the other at Hackney or Kingsland. These are the only two mentioned in the subsequent orders to the porters of the City Gates in 1375; and as late as the reign of Henry VI. they are the only two, besides the ancient Matilda’s Hospital in St Giles’s Fields, to which bequests were made in the will of Ralph Holland, merchant taylor[188]. Another of the suburban leper-spitals was founded at Highgate by a citizen in 1468[189], and it is not until the reign of Henry VIII. that we hear of the spitals at Mile End, Knightsbridge and Hammersmith[190]. By that time leprosy had ceased to be heard of in England; but another disease, syphilis, had become exceedingly common; and it is known that those spitals, together with the older leper-hospitals, were used for the poorer victims of that disease. Stow is unable to give the exact date of any of these foundations except that at Highgate. He assumes that the others were all built on the occasion of the ordinance of 20 Edward III.; but it is probable that only two of them, the Lock and the Kingsland or Hackney spital were built at that time[191].

An early instance of a leper-spital or refuge apparently without ecclesiastical discipline is mentioned in a charter roll of 1207-8, in which king John grants to the leprosi of Bristol a croft outside the Laffard gate, whereon to reside under the king’s protection and to beg with impunity. On the roads leading to Norwich there were four such shelters, outside the gates of St Mary Magdalene, St Bennet, St Giles and St Stephen respectively; these houses were each under a keeper, and were supported by the alms of the townsfolk or of travellers; only one of the four is alleged to have had a chapel attached. The date of these is unknown, but they were probably late. On the roads leading from Lynn, there were three such erections, at Cowgate, Letchhythe and West Lynn, which are first mentioned in a will of 1432. These non-religious and unendowed leper-spitals were probably rude erections on the outskirts of the town, at the door of which, or on the roadside near, one or more lepers would sit and beg. The liberty of soliciting alms was one of their privileges, only they were not allowed to carry their importunity too far; hence the ordinance of most countries that the lepers were not to enter mills and bake-houses; and hence some ordinances of the Scots parliament limiting the excursions of the leper folk. One of the most considerable privileges to lepers was granted to the lepers of Shrewsbury in 1204 by king John, who did not lose the chance of earning a cheap reputation for Christian charity by his ostentatious patronage of the _pauperes Christi_: they were entitled to take a handful of corn or flour from all sacks exposed in Shrewsbury market.

Leper-houses in Scotland and Ireland.

Most of the leper-spitals of Scotland would appear to have been of the poorest kind, unendowed and unprovided with priests. The richest foundation for lepers in Scotland was at Kingcase, near Prestwick in Ayrshire, endowed with lands and consisting of a hospital of eight beds. One or more leper-hospitals were built by the rich abbeys on the Tweed (at Aldcambus in Berwickshire and probably at another place). Another great ecclesiastical centre in Scotland, Elgin, had a leper-house at Rothfan, with accommodation for seven lepers, a chaplain, and a servant. After these, the Scots leper-houses may be taken to have been mere refuges, in which the lepers supported themselves by begging. One such secular hospital was in the Gorbals of Glasgow, founded in 1350. Liberton, near Edinburgh, is supposed to mean Leper-town, and to have been a resort of the sick on account of its medicinal spring. The hospital at Greenside, then outside Edinburgh, was built in 1589. There was a leper-spital outside the Gallow-gate of Aberdeen, on a road which still bears the name of the Spital. Similar shelters may be inferred to have existed at Perth, Stirling, Linlithgow and other places. James IV., in his journeys, used to distribute small sums to the sick folk in the “grandgore” (syphilis), to the poor folk, and to the lipper-folk, “at the town end[192].”

There were some leper-hospitals in Ireland, but it is not easy to distinguish them in every case from general hospitals for the sick poor. Thus the hospital built by the monks of Innisfallen in 869 is merely called _nosocomium_, although it is usually reckoned an early foundation for lepers in Ireland. A hospital at Waterford was “confirmed to the poor” by the Benedictines in 1185. St Stephen’s in Dublin (1344) is specially named as the residence of the “poor lepers of the city” in a deed of gift about 1360-70; a locality of the city called Leper-hill was perhaps the site of another refuge. Lepers also may have been the occupants of the hospitals at Kilbrixy in Westmeath (St Bridget’s), of St Mary Magdalene’s at Wexford (previous to 1408), of the house at “Hospital,” Lismore (1467), at Downpatrick, at Kilclief in county Down, at Cloyne, and of one or more of four old hospitals in or near Cork. The hospital at Galway, built “for the poor of the town” about 1543, was not a leper-house, nor is there reason to take the old hospital at Dungarvan as a foundation specially for lepers[193].

The Prejudice against Lepers.

It will have been inferred, from many particulars given, that the segregation of lepers in the Middle Ages was far from complete, and that many ministered to them without fear and without risk. The same hospital received both _leprosi_ and others, the hospitals were served by staffs of chaplains, clerks and sometimes women attendants; and yet nothing is anywhere said of contagion being feared or of the disease spreading by contagion. The experience of these medieval hospitals was doubtless the same as in the West Indies and other parts of the world in our own day. It is true that the medical writers pronounce the disease to be contagious, _ut docet Avicenna_; but the public would seem to have been unaware of that, and they certainly lost nothing by their ignorance of the medical dogma, which, in the text-books, is merely the result of a concatenation of verbalist arguments. At the same time it is clear that there was a certain amount of segregation of the leprous. The inmates of the hospital at Lincoln are significantly described as “de ejectibus” of the city. The third Lateran Council based one of its decrees upon what must have been a common experience, namely, that lepers were unable to mix freely with others, and that they were objected to in the same church, and even as corpses in the same churchyard. There are some particular indications of that feeling to be gathered from the chroniclers.

One of the most remarkable histories is that of a high ecclesiastic in the pre-Norman period. In the year 1044, Aelfward, bishop of London, being stricken with leprosy (_lepra perfusus_) sought an asylum in the monastery of Evesham, of which he was the prior. The monks may have had more than one reason for not welcoming back their prior; at all events they declined to let him stay, so that he repaired to the abbey of Ramsey, where he had passed his noviciate and been shorn a monk. He carried off with him from Evesham certain valuables and relics; and his old comrades at Ramsey, undeterred by his leprosy or counter-attracted by his treasures, took him in and kept him until his death. The incident can hardly be legendary for it is related in the annals of Ramsey Abbey by one who wrote within a hundred years of the event[194].

Another case, which may also be accepted as authentic, is given by Eadmer in his _Life of Anselm_. Among the penitents who sought counsel and consolation of Anselm while he was still abbot of Bec in Normandy, with a great name for sanctity, was a certain powerful noble from the marches of Flanders. He had been stricken with leprosy in his body, and his grief was all the greater that he saw himself despised beneath his hereditary rank, and shunned by his peers _pro obscenitate tanti mali_[195].

Besides such notable cases, we find more evidence in the ordinances of the hospital of St Julian at St Albans, which have been preserved more completely than those of any other leper-house. Forasmuch as the disease of leprosy is of all infirmities held the most in contempt, the unfortunate person who is about to be received into the St Albans house is directed to work himself up into a state of the most factitious melancholy; he is reminded, not only of the passage in Leviticus about “Unclean, unclean!”, but also of the blessed Job, who was himself a leper (in the 14th century his boils became identified with the plague, and in the end of the 15th century the patriarch was claimed as an early victim of the _lues venerea_); and further of the verse in the 53rd of Isaiah: “Et nos putavimus eum leprosum, percussum a Deo, et humiliatum[196].” The St Albans house, with its six beds, appears to have been carefully managed, and its inmates well provided for; but the unreal atmosphere of the place had been too much for the leprous or other patients of the district; for we find it on record that they could hardly be persuaded to don its russet uniform, and submit themselves for the rest of their lives to its discipline.

There can be no question, then, that persons adjudged leprous were shunned, driven out or ostracised by public opinion, and even legislated against. The reality of these practices should not be confounded with a real need for them. Least of all should they be ascribed to a general belief in the contagiousness of the disease. In practice no one heeded the medical dogma of leprous contagion, because no one attached any concrete meaning to it or had any real experience of it. There was prejudice against lepers, partly on account of Biblical tradition, and partly because the “terribilis aspectus” of a leper was repulsive or uncanny. Further, in genuine leprosy, the most wretched part of the victim’s condition was not his appearance (which in a large proportion of cases may present little that is noticeable to passing observation), but his unfitness for exertion, his listlessness, and depression of spirits, owing to the profound disorganisation of his nerves. A leprous member of a family would be a real burden to his relatives; and in a hard and cruel age he would be little better off than the stricken deer of the herd or the winged bird of the flock. To become a beggar was his natural fate; and as a beggar he became privileged, by royal patent or by prescription, while beggars in ordinary were under a ban.

It is undoubted that the privilege of begging accorded to lepers was abused, and was claimed by numbers who feigned to be lepers[197]. The one severe edict against lepers in England was the ordinance of Edward III. for the exclusion of lepers from London in 1346; it is clear, however, from the text of the ordinance that the occasion of it was not any fixed persuasion of the need for isolating leprous subjects, but some intolerable behaviour of lepers or of those who passed as such. The mayor and sheriffs are ordered to procure that all lepers should avoid the city within fifteen days, for the reason that persons of that class, as well by the pollution of their breath, etc. “as by carnal intercourse with women in stews and other secret places, detestably frequenting the same, do so taint persons who are sound, both male and female, to the great injury etc.[198]” That is the old confusion which we have already noticed in Bernard Gordonio and Gilbert; it is an edict against _lepra_ in its generic sense, and against the same class that William Clowes characterizes so forcibly in his book on the _morbus Gallicus_ in 1579. At a date intermediate between those two, in 1488, an order was made by the provost of Paris, that “lepers” should leave the city; but that is too late a date for leprosy, although not too early for syphilis. On the 24th August, 1375, the porters of the City Gates were sworn to prevent lepers from entering the city, or from staying in the same, or in the suburbs thereof; and on the same date, the foreman at ‘Le Loke’ (the Lock Hospital in Southwark) and the foreman at the leper-spital of Hackney took oath that they will not bring lepers, or know of their being brought, into the city, but that they will inform the said porters and prevent the said lepers from entering, so far as they may[199].

When all word of leprosy had long ceased in England the porters of the City Gates had the same duties towards beggars in general. Thus in Bullein’s _Dialogue_ of 1564, the action begins with a whining beggar from Northumberland saying the Lord’s Prayer at the door of a citizen. The citizen asks him, “How got you in at the gates?” whereupon it appears that the Northumbrian had a friend at Court: “I have many countrymen in the city,” among the rest an influential personage, the Beadle of the Beggars[200].

While it cannot be maintained that lepers were tolerated or looked upon with indifference, yet it was for other reasons than fear of contagion that they were objectionable. The prejudices against them have been already illustrated from periods as early as the eleventh century. They were, to say the least, undesirable companions, and in certain occupations they must have been peculiarly objectionable. Thus, on the 11th June, 1372, in the city of London, John Mayn, baker, who had often times before been commanded by the mayor and aldermen to depart from the city, and provide for himself some dwelling without the same, and avoid the common conversation of mankind, seeing that he the same John was smitten with the blemish of leprosy--was again ordered to depart[201]. It does not appear whether the baker departed that time, nor is there any good diagnosis of his leprosy; there was certainly a prejudice against him, but the occasion of it may have been nothing more than the eczematous crusts on the hands and arms, sometimes very inveterate, which men of his trade are subject to.

It is clear also from a singular case in the _Foedera_, that a false accusation of leprosy was sometimes brought against an individual, perhaps out of enmity, like an accusation of witchcraft. In 1468 a woman accused of leprosy appealed to Edward IV., who issued a chancery warrant for her examination.

The writ of 3rd July, 1468, is to the king’s physicians, “sworn to the
safe-keeping of our person,” William Hatteclyff, Roger Marschall, and
Dominic de Serego, doctors of Arts and Medicine; and the subject of
the inquisition is Johanna Nightyngale of Brentwood in Essex, who was
presumed by certain of her neighbours to be infected by the foul
contagion of _lepra_, and for whose removal from the common
intercourse of men a petition had been laid in Chancery. She had
refused to remove herself to a solitary place, _prout moris est_; the
physicians are accordingly ordered to associate with themselves
certain legal persons, to inquire whether the woman was leprous, and,
if so, to have her removed to a solitary place _honestiori modo quo
poteris_. On the 1st of November, 1468, the court of inquiry reported
that they found the woman to be in no way leprous, nor to have been.
The woman had been brought before them: they had passed in review
twenty-five or more of the commonly reputed signs of _lepra_, but they
had not found that she could be convicted of leprosy from them, or
from a sufficient number of them; again, passing in review each of the
four species of lepra (_alopecia_, _tinia_, _leonina_, and
_elephantia_) and the forty or more distinctive signs of the species
of _lepra_, they found not that the woman was marked by any of the
species of _lepra_, but that she was altogether free and immune from
every species of _lepra_[202].

Laws against Lepers.

The ordinance of 21 Edward III. (1346) against the harbouring of lepers in London is the only one of the kind (so far as I know) in English history; the Statutes of the realm contain no reference to lepers or leprosy from first to last; the references in the Rolls of Parliament are to the taxing of their houses and lands. The laws which deprived lepers of marital rights and of heirship appear to have been wholly foreign; in England, leprosy as a bar to succession was made a plea in the law courts. It appears, however, that a law against lepers was made by a Welsh king in the tenth century[203]. It is not easy to realize the state of Welsh society in the tenth century; but we know enough of it in the twelfth century, from the description of Giraldus Cambrensis, to assert with some confidence that “leprosy” might have meant anything--perhaps the “lepra Normannorum[204].”

In Scotland the laws and ordinances, civil and ecclesiastical, against lepers have been more numerous. In 1242 and 1269, canons of the Scots Church were made, ordering that lepers should be separated from society in accordance with general custom. In 1283-84, the statutes of the Society of Merchants, or the Guildry, of Berwick provided that lepers should not enter the borough, and that “some gude man sall gather alms for them.” In 1427 the Parliament of Perth authorised ministers and others to search the parishes for lepers[205].

We conclude, then, that little was made of leprosy by English legislators (rather more by the Scots), just as we have found that in the endowment of charities, the leprous had only a small share, and that share a somewhat exaggerated one owing to the morbid sentimentality of the chivalrous period. The most liberal estimate of the amount of true leprosy at any time in England would hardly place it so high as in the worst provinces of India at the present day. In the province of Burdwan, with a population of over two millions, which may be taken to have been nearly the population of England in the thirteenth century, there are enumerated 4604 lepers, or 2·26 in every thousand inhabitants. But even with that excessive prevalence of leprosy, and with no seclusion of the lepers, a traveller may visit the province of Burdwan, and not be aware that leprosy is “frightfully common” in it. In medieval England the village leper may have been about as common as the village fool; while in the larger towns or cities, such as London, Norwich, York, Bristol, and Lincoln, true lepers can hardly have been so numerous as the friars themselves, who are supposed to have found a large part of their occupation in ministering to their wants. A rigorous scepticism might be justified, by the absence of any good diagnostic evidence, in going farther than this. But the convergence of probabilities does point to a real prevalence of leprosy in medieval England; and those probabilities will be greatly strengthened by discovering in the then habits of English living a _vera causa_ for the disease.

Causes of Medieval Leprosy.

What was there in the medieval manner of life to give rise to a certain number of cases of leprosy in all the countries of Europe? Granting that not all who were called _leprosi_ and _leprosae_, were actually the subjects of _lepra_ as correctly diagnosed, and that the misnomer was not unlikely to have been applied in the case of princes, nobles and great ecclesiastics, we have still to reckon with the apparition of leprosy among the people in medieval Europe and with its gradual extinction, an extinction that became absolute in most parts of Europe before the Modern period had begun.

Of the “importation” of leprosy into Britain from some source outside there can be no serious thought; the words are a meaningless phrase, which no one with a real knowledge of the conditions, nature and affinities of leprosy would care to resort to. The varying types of diseases, or their existence at one time and absence at another, are a reflex of the variations in the life of the people--in food and drink, wages, domestic comfort, town life or country life, and the like. No one doubts that the birth-rate and the death-rate have had great variations from time to time, depending on the greater or less abundance of the means of subsistence, on overcrowding, or other things; and the variation in the birth-rate and death-rate is only the most obvious and numerically precise of a whole series of variations in vital phenomena, of which the successions, alternations, and novelties in the types of disease are the least simple, and least within the reach of mere notional apprehension or mere statistical management. The apparition and vanishing of leprosy in medieval Europe was one of those vital phenomena. It may be more easily apprehended by placing beside it a simple example from our own times.

The pellagra of the North Italian peasantry (and of Roumania, Gascony and some other limited areas) is the nearest affinity to leprosy among the species of disease. Strip leprosy of all its superficial and sentimental characters, analyse its essential phenomena, reduce its pathology to the most correct outlines, and we shall find it a chronic constitutional malady not far removed in type from pellagra. In both diseases there are the early warnings in the excessive sensibility, excessive redness and changes of colour, at certain spots of skin on or about the face or on the hands and feet. In both diseases, permanent loss of sensibility follows the previous exaggeration, blanching of the skin will remain for good at the spots where redness and discoloration were apt to come and go, and these affections of the end-regions of nerves will settle, in less definite way, upon the nervous system at large,--the cerebro-spinal nervous system, or the organic nervous system, or both together. What makes leprosy seem a disease in a different class from that, is the formation of nodules, or lumps, in the regions of affected skin in a certain proportion of the cases. If leprosy were all anaesthetic leprosy, its affinities to pellagra would be more quickly perceived; it is because about one-half of it has more or less of the tuberculated character that a diversion is created towards another kind of pathology. But the fact that some cases of leprosy develop nodules along the disordered nerves does not remove the disease as a whole from the class to which pellagra belongs. In both diseases we are dealing essentially with a profound disorder of the nerves and nerve-centres, commencing in local skin-affections which come and go and at length settle, proceeding to implicate the nervous functions generally, impairing the efficiency of the individual, and bringing him to a miserable end. The two diseases diverge each along its own path, leprosy becoming more a hopeless disorder of the nerves of tissue-nutrition, and so taking on a structural character mainly but not exclusively, and pellagra becoming more a hopeless disorder of the organic nervous system (digestion, circulation, etc.) with implication of the higher nervous functions, such as the senses, the intellect, and the emotions, and so taking on a functional character mainly but not exclusively. The correlation of structure and function is one that goes all through pathology as well as biology; and here we find it giving character to each of two chronic disorders of the nervous system, according as the structural side or the functional side comes uppermost.

What, then, are the circumstances of pellagra, and do these throw light upon the medieval prevalence of leprosy? Pellagra has been proved with the highest attainable scientific certainty to be due to a staple diet of bread or porridge made from damaged or spoilt maize. It followed the introduction of maize into Lombardy at an interval of two or three generations, and its distribution corresponds closely to the poorer kinds of maize on colder soils, and to the class of the peasantry who get the worst kind of corn or meal for their food. The cases of the disease among the peasantry of Lombardy and some other maize-growing provinces of Northern Italy, were about one hundred thousand when last estimated; the endowed charitable houses and lunatic asylums are full of them. The connexion of the disease with its causes is perfectly well understood; but the economic questions of starvation wages, of truck, of large farms with bailiffs, and of agricultural usage, have proved too much for the chambers of commerce and the Government; so that there is as yet little or no sign of the decline of pellagra in the richest provinces of Italy. This disease is not mentioned in the Bible, therefore it has no traditional vogue; it is not well suited to knight-errantry, because it is a common evil of whole provinces; its causes are economic and social, therefore there is no ready favour to be earned by systematic attempts to deal with them; and there is absolutely no opening for heroism and self-sacrifice of the more ostentatious kind. These are among the reasons why this great object-lesson of a chronic disorder of nutrition, proceeding steadily before our eyes, has been so little perceived. It is in pellagra, however, that we find the key to the ancient problem of leprosy. The two diseases are closely allied in the insidious approach of their symptoms, in their implicating the tissue-nutrition through the nerves, or the nervous functions through the nutrition, in their cumulating and incurable character, and in their transmissibility by inheritance. Thus nosologically allied, they may be reasonably suspected of having analogous causes; and as we know the cause of modern pellagra to be something noxious in the habitual diet of the people, we may look for the cause of medieval leprosy in something of the same kind.

The dietetic cause is not far to seek, and it cannot be stated better than in the following well-known passage by the philosophical Gilbert White in his _Natural History of Selborne_[206]:--

“It must, therefore, in these days be, to a humane and thinking
person, a matter of equal wonder and satisfaction, when he
contemplates how nearly this pest is eradicated, and observes that a
leper is now [1778] a rare sight. He will, moreover, when engaged in
such a train of thought, naturally inquire for the reason. This happy
change perhaps may have originated and been continued from the much
smaller quantity of salted meat and fish now eaten in these kingdoms;
from the use of linen next the skin; from the plenty of bread; and
from the profusion of fruits, roots, legumes, and greens, so common in
every family. Three or four centuries ago, before there were any
enclosures, sown-grasses, field-turnips, or field-carrots, or hay, all
the cattle which had grown fat in summer, and were not killed for
winter use, were turned out soon after Michaelmas to shift as they
could through the dead months; so that no fresh meat could be had in
winter or spring. Hence the marvellous account of vast stores of
salted flesh found in the larder of the eldest Spencer even so late in
the spring as the 3rd of May (600 bacons, 80 carcases of beef, and 600
muttons)[207]. It was from magazines like these that the turbulent
barons supported in idleness their riotous swarms of retainers, ready
for any disorder or mischief. But agriculture is now arrived at such
pitch of perfection, that our best and fattest meats are killed in the
winter; and no man needs eat salted flesh, unless he prefers it, that
has money to buy fresh.

“One cause of this distemper might be no doubt the quantity of
wretched fresh and salt fish consumed by the commonalty at all seasons
as well as in Lent, which our poor now would hardly be persuaded to
touch.... The plenty of good wheaten bread that now is found among all
ranks of people in the south, instead of that miserable sort which
used, in old days, to be made of barley or beans, may contribute not a
little to the sweetening their blood and correcting their juices.”

Let us add to this, that the meat diet of the poorer class, whether serfs or freemen, would be apt to consist of the more worthless portions, the semi-putrid pieces in the salted sides of bacon, mutton or beef, and that badly-cured pork was in many parts the usual kind of flesh-food; and we shall have no difficulty in finding the noxious element in the diet of the Middle Ages, which the dietetic hypothesis of leprosy requires. Some who have advocated that hypothesis for modern leprosy, have laid themselves open, notwithstanding the ability and industry of their research, to plausible objections which have no bearing if the hypothesis be sufficiently safe-guarded. Leprosy, like every other _morbus miseriae_, needs a number of things working together to produce it, its more or less uniform specific character or distinctive mark being determined by the presence of one factor in particular. The special factor should be generalised as much as possible, so as to cover the whole circumstances of leprosy: it is not only half-cured or semi-putrid fish[208], but half-cured or semi-putrid flesh of any kind. The most general expression for leprosy is a semi-putrid or toxic character of animal food, just as for the allied pellagra, it is a semi-putrid or toxic character of the bread or porridge. Moreover it is that noxious or unnatural thing in the food, not once and again, or as a _bonne bouche_, but somewhat steadily from day to day as a chief part of the sustenance, and from year to year. As the rain-drops wear the stones, so the poison in the daily diet tells upon the constitution. Once more, such special causes may be present in a country generally, among the poor of all the towns, villages and hamlets, and yet only one person here and there may show specific effects that are recognisable as a disease to which we give a name. Unless there be present the aiding and abetting things, the special factor will hardly make itself felt; and if there be not the special factor, there may be some other _morbus miseriae_ but there will not be that one. These aiding things are for the most part the usual concomitants of poverty and hardships, wearing out the nerves far more than is commonly supposed and producing in ordinary an excessive amount of nervous affections among the poor. But among the poor themselves, as well as among the well-to-do, there are special susceptibilities in individuals and in families. One person may have the same unwholesome surroundings as another and the same poisonous element in his diet, but he may fall into no such train of symptoms as his leprous neighbour because he is not formed in quite the same way, because he has “no nerves,” or is of a hardier stock, or because his unwholesome manner of life comes out in some other form of disease (scrofula perhaps, less probably gout), or for some other reason deeply hidden in his ancestry and his personal peculiarities. The chances would be always largely against that particular combination of factors needed to make leprosy. It was a _morbus miseriae_ of the Middle Ages, but on the whole not a very common one; and it was easily shaken off by the national life when the conditions changed ever so little. It was all the more easily shaken off by reason of the facilities for divorce, the prohibition of marriage, and the monastic discipline.

The staple diet as a cause of leprosy was suspected in the Middle Ages, and by writers as ancient as Galen. It is not without significance that the minute directions for the dieting of the lepers in the rich hospital of Sherburn, near Durham, urge special caution as to the freshness of the fish: when fresh fish was not to be had, red herrings might be substituted, but only if they were well cured, not putrid nor corrupt. Those directions were in accordance with the best medical teaching of the time on the dietetics of leprosy, or on how to prevent leprosy, as it is given with considerable minuteness in Gordonio and Gilbert[209].

On the other hand we find a singular ordinance of the Scots Parliament at Scone in 1386, or some forty years after the date of the Durham regulations: “Gif ony man brings to the market corrupt swine or salmond to be sauld, they sall be taken by the Bailie and incontinent without ony question sall be sent to the lepper-folke; and gif there be na lepper-folke, they sall be destroyed alluterlie[210].” Nothing could be more significant for the prevalence and persistence of leprosy in Scotland[211]. Putrid fish and pork did actually come to market; the dangers of them as regarded the production of leprosy were unsuspected; and the lepers (genuine or mistaken) were actually directed to be fed with them. Such food for “lepers” could only have fed the disease; and if it be the case that genuine leprosy was met with in Edinburgh and Glasgow more than two centuries after it ceased to be heard of in England, we need be at no loss to assign the reason why the disease was more inveterate in the one country than in the other.