Leprosy in Medieval England (review)

No disease, except the plague, is more commonly associated with the "Dark Ages" than leprosy. The lurid associations are dispelled in this luminous book by Carole Rawcliffe, who has written the most comprehensive and accessible history to date. Revisionist in the best sense, Rawcliffe relies on solid primary evidence to set the record straight while deconstructing modern misrepresentations. The persistent stereotypes, which gained broader currency in the 1980s' reactions to AIDS, are mainly figments of nineteenth-century fears and fantasies. Leprosy in Medieval England persuasively demonstrates that, contrary to these stereotypes, what we now know as Hansen's disease was neither ubiquitous nor the result of general squalor; it was neither grossly misdiagnosed nor categorized as a venereal disease; patients were not utterly abandoned by medicine, and their banishment was neither universal nor ritualized with mock funerals; and charitable impulses rather than epidemic pressures or fears of contagion inspired the foundation of leper shelters, most of which were small. The myths were exposed by François-Olivier Touati in Maladie et société au Moyen Âge: La lèpre, les lépreux et les léproseries dans la province ecclésiastique de Sens jusqu'au milieu du XIVe siècle (Paris, 1998). However, Touati's monumental work is unlikely to become available in translation, and Rawcliffe's vantage point affords a special perspective on the elaborate English mythology. The label "leper" carries a stigma, harsher than equivalents in most European languages, that is largely a Victorian rather than a Chaucerian legacy.

Rawcliffe treats leprosy as the multifaceted topos of a medievalist, with sources ranging from literature to medicine and from theology to foundation documents. The analysis, structured rather loosely, proceeds from ideas about causation to diagnostic practices, therapeutics, and hospitalization, with the interjection of a chapter on reactions to suffering and another on the extent of segregation. The narrative, enlivened by fascinating (albeit incompletely exploited) anecdotes, interweaves allegorical, spiritual, physical, social, and political strands into a colorful panorama. Occasionally the dazzle of a millefleur tapestry blurs lines that should define, for example, the relationship between ecclesiastical and medical concerns, or the distinctly English patterns.

Leprosy in Medieval England is more than a localized version of the West European history of leprosy because it reveals significant differences. In general, English records offer comparatively scant information on the examination of suspects, the organization of lazar hospitals, and the involvement of physicians. A most noteworthy insular characteristic is the limited involvement of university medicine in intellectual and social responses. The near invisibility of Oxford and Cambridge stands in sharp contrast to the high profile of medical faculties from Montpellier to Cologne. Academic discussion of the definition, causes, and symptoms of lepra was minimal, as was the reliance on Avicenna's conceptual framework that governed continental theory and practice.

No learned physicians served as municipal health commissioners in England, as they did in numerous towns on the mainland. Inversely, clergy maintained authority in the reporting and judging of patients far longer than in France and Germany. Although preachers on both sides of the channel portrayed heresy as spiritual leprosy, England lacked "the association with heresy that led to vilification and persecution on the continent" in Rawcliffe's (perhaps too sweeping) view (p. 355).

It is pertinent for this reviewer to mention a brief but consequential meeting with the author in 2003, when our paths crossed with similar work in progress. We believed that differences in methodology, thematic focus, and chronological scope would minimize overlap between the resulting books. Nevertheless, a concern with potential duplication was one reason for excluding England from my own inquiry for Leprosy in Premodern Medicine: A Malady of the Whole Body (Baltimore: Johns Hopkins University Press, 2007). The exclusion initially troubled my advisers, but it allowed me to concentrate on continental sources, particularly the scores of academic writings and hundreds of medical affidavits, which have no counterpart in England. Leprosy in Medieval England, however, reveals both the richness of insular testimony and the value of further comparative...