Maladie et societe au Moyen Age: la lepre, les lepreux et les leproseries dans la province ecclesiastique de Sens jusqu'au milieu du XIVe siecle (review)

The Premier Grand Prix de la Société Française d’Histoire des Hôpitaux, with which this book was honored, should not eclipse the fact that the author’s purview ranges far beyond the history of hospitals. His monumental study (growing out of his 1992 four-volume doctoral dissertation) is anchored in a detailed inventory of institutional archives from the ecclesiastical province of Sens,¹ but it opens panoramic perspectives. Endeavoring to write all-embracing history, Touati sets his analysis of documents in a broad cultural and political context; he marshals topographical, archaeological, and artistic evidence (yielding some remarkable illustrations) in addition to the widest variety of written sources; and he draws on insights from anthropology, sociology, and psychology. As a result, the vicissitudes of 395 medieval leper communities, most of which were founded before 1150, illuminate universal dynamics inherent in defining a disease and dealing with the afflicted.

Almost every axiom in the common presentation of medieval leprosy is challenged in Maladie et société au Moyen Age. In an opening survey of the historiography, Touati methodically dismantles stereotypes, accumulated over the past four centuries, that misrepresent leprosy as having been the scourge of the Middle Ages—ubiquitous and feared obsessively, perceived as highly contagious, and inevitably tied to confinement. In the process, he exposes anachronisms of prominent historians— including medievalist Georges Duby, leprologist Édouard Jeanselme, and even Michel Foucault—whose ideas influenced this book. No icons are spared, from Enlightenment luminaries (Voltaire, Benjamin Rush) who compounded chronological bias with racist hypotheses, to early AIDS activists who fought calls for sequestration by conjuring up the image of medieval phobias and internment as reactions to the spread of leprosy.

As Touati argues emphatically and cogently, notions of contagiousness and protective isolation neither led to the foundation of leprosaria nor flowed from the threat of a leprosy epidemic. Prejudices emerged late and sporadically, finding their first sharp expression in a climate of unrest at the beginning of the fourteenth century, when leper houses were already in decline (and, in fact, inhabited by a majority of uninfected residents). Over the course of three centuries, the most pervasive changes in attitudes and measures were gradual, and they followed developments in value systems rather than in morbidity. In the religious formulation that prevailed until the early twelfth century, leprosy was perceived first as a reminder of human weakness and then as a mark of divine will; increasingly secularized, the perception shifted to an emphasis on personal defect, and leprosy was eventually medicalized as a communicative disease. The response to lepers deteriorated from compassion for the “poor sick” to impatience with unruly beggars, to suspicion of “the other,” and, in the end, to exclusion of the unwanted. Lazar houses were transformed from charitable shrines and quasi-monastic shelters for existing groups of infirm, to viable communities in the midst of an expanding society, to pawns of patronage, and finally to institutions plagued by external interference, economic distress, and internal friction. The darkest side of the retrogression is evoked in the devaluation of the leper’s clapper, from a symbol of inclusion to one of exclusion: originally calling monks together around an ailing brother, subsequently it summoned the attention of almsgivers, and, considerably later, it turned into an alarm that warned of an approaching and vagrant outcast.

This reconstruction, to be buttressed with a forthcoming edition of three cartularies, will probably be definitive for the heartland of the French realm. It is, however, hardly the final word on medieval leprosy, as Touati is the first to admit. We need equally painstaking inventories for other areas, and comparative studies across geographic and...