Carole Rawcliffe, Leprosy in medieval England, Woodbridge, Boydell Press, 2006, pp. xiii, 421, illus., £60.00, $105.00 (hardback 1-184383 2739).

Abstract

After many case studies of hospital history, this book is an eagerly awaited synthesis of the history of leprosy in England. The author, a specialist in English society and its medical practices at the end of the Middle Ages (her Medicine and society in later medieval England [Stroud, Alan Sutton] appeared in 1995), offers a panorama of this disease which even today remains emblematic of the “dark” Middle Ages. Invited to London in 1994 by the Wellcome Institute for the History of Medicine, I had the opportunity to read a paper on the process and challenges of the historiographic construction of this image since the Enlightenment (see ‘Contagion and leprosy: myth, ideas and evolution in medieval minds and societies’, in L Conrad and D Wujastyk [eds], Contagion: perspectives from premodern societies, Aldershot, Ashgate, 1999, pp. 161–83). Imagine my delight to see my thoughts being used for an updated approach to the subject, avoiding the “worst leprosy of the historian”—anachronism. The first chapter ‘Creating the medieval leper’ is thus fundamental for the analysis as a whole and guards against the risk of misinterpretations. It reveals an original mind with a thorough knowledge of the whole range of bibliography—medical, missionary, literary and, finally, historical—produced until the present. Walter Scott or Ellis Peters could have been added to this troupe. For it is always difficult to conceive of sensitivities or attitudes vis-a-vis the disease and its sufferers that differ from our own explanatory conceptions, themselves built on different bases. What ideas about contagion could have been expressed before the discovery of bacilli, the invention of the microscope and the disappearance of galenic medicine? How much value can be given to medieval diagnosis and identification of the disease? How can we interpret what today looks like “segregation” if we do not understand that these patients, readily seen as living embodiments of the suffering Christ, were held in extraordinarily high regard? The first skeletal evidence of leprosy appears in England at Dorchester in the fourth century, but institutional provision seems not to have been established until the Norman Conquest by Lanfranc at Canterbury and Gundulf of Rochester at Chatham. Three hundred and twenty leper-houses have been identified up to the fifteenth century and the way of life of the inmates—men and women—was very similar to that of a religious order: praying in peaceful surroundings for the salvation of their benefactors. Numerous donations continued throughout the Middle Ages although the wave of foundations ended well before the Black Death, but contrary to what the author thinks, they may not always have been “small gifts” (p. 109). Few cartularies holding the title deeds, such as those of Saint-Lazarus at Melton Mowbray or St Bartholomew's Dover, remain, but the land extent was often considerable. As charitable foundations, these establishments originated from a varying perception of the causes of the disease. Body and soul being inseparable according to medieval thinking (chapter 2), disease could be a metaphor for sin, the reason for political denigration (as in the case of the Henry IV, d. 1413), but also a mark of sanctification, swiftly arousing surprising gestures of devotion, frequent acts of kindness to the sick, and producing models of piety, such as Queen Mathilde, wife of king Henri Beauclerc, for example. Following careful examinations in which priests and physicians took turns to scrutinize patients with extreme meticulousness for the signs of leprosy, the diagnoses were not pronounced lightly and the experts at times resorted to judicia (the first in 1227). Although based on humoral interpretation, their examinations included all the observations and criteria possible, even, for example, tests on the coagulation of the blood. Many interesting cases are recounted in this book—they increased notably from the fourteenth century. The remedies were no less elaborate: diet, ointments, baths, surgical purgings, and even castration as undergone by the bishop of London, Hugues of Orival (d. 1085). The opprobrium he suffered as a result was due to his becoming a eunuch, not because he was a leper. The major question of segregation is here given a nuanced analysis. Life in the leper-houses, far from being one of exclusion, reveals varied degrees of isolation and considerable involvement in social and economic life outside. The difference between theory and practice is carefully reconstructed by the author. Although, perhaps, chronological developments at the levels of both medicine and social perception could have been better clarified. The slight confusion when the great canonist and bishop of Chartres Yves (Ivo) is named by error “Odo” (p. 122) suggests how much the richness of the data, gathered here in a remarkable way, deserves a comparison with Normandy, a country that pioneered work with lepers and with sufferers from other illnesses in general. England and Normandy, of course, share the same history, not only politically. This important contribution, therefore, leaves us hoping for further equally enlightening studies.