contributor.author: Sally Crawford

title.none: Rawcliffe, Leprosy (Sally Crawford)

identifier.other: baj9928.0705.031 07.05.31

identifier.issn: 1096-746X

description.statementofresponsibility: Sally Crawford, University of Birmingham, s.e.e.crawford@bhma.ac.uk

publisher.none: .

date.issued: 2007

identifier.citation: Rawcliffe, Carole. Leprosy in Medieval England. Woodbridge, UK: Boydell Press, 2006. Pp. 440. $105.00 (hb) ISBN-10: 1843832739, ISBN-13:9781843832737. ISBN: .

type.none: Review

relation.ispartof: The Medieval Review

The Medieval Review 07.05.31

Rawcliffe, Carole. Leprosy in Medieval England. Woodbridge, UK: Boydell Press, 2006. Pp. 440. $105.00 (hb) ISBN-10: 1843832739, ISBN-13:9781843832737. ISBN: .

Reviewed by:

Sally Crawford
University of Birmingham
s.e.e.crawford@bhma.ac.uk

The importance of this book's contribution to our understanding of medieval English responses to disease cannot be understated. In this comprehensive, thoughtfully argued, compelling, fascinating, rigorous and extensively researched work, Carole Rawcliffe sets out to disabuse the reader of all the most dearly-held modern popular and scholarly misconceptions of the medieval leper, and succeeds. If your understanding of medieval leprosy is that medieval lepers were excluded, reviled, compulsorily segregated from the healthy population and removed to edges of society, only to live out the rest of their miserable days in a state of living death, with a clapper bell to warn all to keep away from them--if you thought any part of this description corresponded with a medieval reality, then you need to read this book.

Rawcliffe's first task is to track the way in which often wilful misreadings of the past have created a hard carapace of misinformation about medieval leprosy. In fact, as she demonstrates, most of the stereotypical images of the medieval leper described above originated in the nineteenth century. Many of the central planks in the construct of the segregated leper are shown to be either seriously weak or completely rotten. There is no evidence whatsoever that the popular and infamous "Leper Mass", in which the medieval leper was supposedly to be pronounced dead to the world and debarred from human society, was ever used in medieval Britain, and the writ de leproso amovendo, often cited by scholars as having been widely used in medieval England to forcibly remove suspected lepers from contact with the healthy, is invisible in English texts until a reference was made to it in 1531. Earlier records that show authorities making a direct intervention in the removal of lepers were either responses to intransigent individuals, whose flagrant behaviour and persistently provocative refusals to respond to civic requests caused their expulsion, or were intended to target vagrants, prostitutes and other visible undesirables, usually following outbreaks of plague.

The Lateran Council of 1215 commented that "sickness of the body may sometimes be the result of sin", but individual cases undermine generalisations, as medieval thinkers recognised. How was the leprosy of King Baldwin IV of Jerusalem, an otherwise exemplary Christian, leader and warrior, to be placed within the framework of medieval concepts of sickness and sin? Rawcliffe's work emphasizes that modern historians need to give due recognition to complex medieval responses to the relationship between sin and illness, and to place pronouncements such as that of the Lateran Council in their proper context. The medieval church might have insisted on the pre-eminence of confession over medicine for those diagnosed with leprosy, but Rawcliffe challenges any assertion that this represents discrimination against lepers, and suggests instead that "repentance and the expiation of sin through penance were the essential parts of a cumulative process, at which it might be argued the sick excelled above all others" (132). Confession, contrition, repentance and punishment need to be seen within the framework of everyday medieval life, where everyone was a sinner.

The leprous sick were also useful as vehicles for the expiation and atonement of sins; remission for penance was available to visitors to the house of St. Mary Magdalen and St. James, Chichester, for example, but of course the justification for the power of lepers to help sick souls was that lepers themselves were perceived as monstrous and revolting. The church offered ambivalent readings of the leprous body. Disfigured like Christ on the Cross, "gifted" with soul-cleansing purgatory on earth, but also displaying fragmenting bodies that prefigured the torments of hell, the distorted, suppurating bodies of lepers were "profoundly disturbing" to medieval men and women, physically, socially, and ecclesiastically, and defied simple explanations or categorisations.

Clerics and lay people alike may have viewed leprosy as a form of purgatory on earth, but this did not prevent lepers and members of their social networks from seeking medical help. Rawcliffe is uncompromising in leaving no scope for modern sneering at the skills of medieval medical practitioners. She carefully proves that doctors routinely employed a range of tests, including blood and urine tests, and had a checklist of up to sixty symptoms to diagnose the type and severity of the leprosy. In addition, university-trained physicians did not have a monopoly on this information. Texts on the subject were widely available to a growing literate population. Medieval doctors had developed a sophisticated, holistic approach to the body, based on observation, learning and tradition, in which the sick person's needs extended beyond herbs and chemicals to include diet, environment, spiritual and emotional health, and the movements of planets and stars. A medieval practitioner who limited treatment of the leper to ointments and medicines in the modern manner, without giving due attention to these other factors, would have been negligent.

Once leprosy had been diagnosed (not always a simple matter: several suspects successfully litigated against their accusers by bringing in expert witnesses), far from being carted off to isolated leper houses at the first whiff of the disease, lepers competed for places in these monastic or quasi-monastic institutions, and competition could be stiff. By 1350, England had a "bare minimum" of 320 leper houses, but the genuinely poor lepers for whom many leprosaria were founded were increasingly edged out of beds by the practice of selling places to healthier, wealthier pensioners. Leper houses were places of security and refuge, offering clothing, warmth, friendship, food and palliative care. Clothing conformed to general monastic habits: there is absolutely no evidence for a specific costume to distinguish lepers from other people. Far from being cut off from the rest of society, the inmates of these houses received visitors, and were allowed to travel. Withdrawal of such privileges was one of the penalties for infringing the rules of the house. Contrary to the medieval myth, inmates were not imprisoned in leprosaria. In fact, the ultimate deterrent for inappropriate behaviour was the threat of temporary or permanent exclusion from the house. Furthermore, a leper house without access to a constant stream of passers-by would be cut off from the alms that underpinned its economic survival. Even rural houses were situated on major thoroughfares or routeways, often at crossroads, or at the crossing point of rivers. No traveller to medieval Norwich, for example, could avoid the attention of a leprous beggar from one of the many lazar houses strategically situated by every approach road to the city.

Most leprosaria, like other charitable medieval institutions, adhered to monastic or quasi-monastic rules, which required abstinence and devotion from their carefully-selected inmates. Not all lepers wanted to give up their family lives, even if their finances, moral standing or connections allowed them to join these exclusive leper communities. The records from medieval Yarmouth, for example, list at least twenty-one female lepers living with their husbands, including one Beatrice Eston, who stayed with John, her husband, in cheerful defiance of the public nuisance orders filed against her for ten consecutive years by the jurors of Yarmouth.

Rawcliffe offers ample evidence that the same levels of ambivalence over segregating the lepers in medieval life pertained in death, too. Segregated cemeteries did exist, but archaeological and documentary evidence demonstrate that lepers were also buried in ordinary cemeteries, and vice versa (and Rawcliffe has already taught us that misdiagnosis was unlikely in either case).

Having demolished beyond retrieval the idea that the medieval English leper was "a reluctant prisoner, locked away behind high walls, or relegated to some distant settlement miles from human habitation" (345), Rawcliffe finally turns her attention to the last myth of modern segregationists--that rigid exclusion of lepers was responsible for the disappearance of leprosy and leprosaria from the British Isles. Due consideration is given to the possible impact of improved diet and housing, a change in climate, changing ideas about the disease and its transmission, and developing resistance to the disease, but in the end, as might be expected, just as the founding of leprosaria in the twelfth and thirteenth centuries was prompted by specific ideas about the relationship between sickness, piety and remission from sins, so the decline in leper houses was almost certainly due to social and economic factors. Changing fashions in lay piety and philanthropy meant that the monastic life no longer seemed so attractive to secular men and women, including lepers. Leper houses faced competition for alms from new mendicant orders, and there were legal developments, such as the Statute of Mortmain of 1279, which forbade the alienation of land to the church without a costly royal licence. The final straw was for many smaller houses was the economically crippling effect of a combination of the Black Death and bad harvests.

Above all, this book stresses that the study of medieval leprosy is the study of individual responses and individual lives. The medieval sick cannot be pigeon-holed or defined by their illnesses, any more than they can today. Feisty Alice Dymock of Yarmouth, thief, procuress, adulterer, scold, unlicensed seller of ale, and "provoker of quarrels", appeared regularly before the courts of Yarmouth over a number of years, until the authorities at last forced her out by presenting her as a leper (after which her final, brilliant act of vengeance was to milk her neighbours' cows). She was a very different leper to the respectable, well-connected, carefully-vetted voluntary inmates of the various leprosaria, where priests were counselled that they should never name the disease, but only allude to it in most general terms, for fear of causing upset. In her closing discussion, Rawcliffe makes a plea for any study of historical responses to disease to consider the "spiritual and intellectual milieu of the afflicted, and assess on their own terms the various stratagems with which they fought, individually and collectively, for survival" (357). She argues against viewing the history of disease in modern, medicalised terms, and in this lively text, with copious footnotes, an extensive bibliography and useful illustrations, she offers a compassionate, compelling, and important model for (re)writing the history of disease.