Leprosy in Premodern Medicine: A Malady of the Whole Body (review)

Of all of the afflictions to haunt the European past, leprosy exercises a particular fascination over the collective imagination. Since the nineteenth century, when a potent combination of colonialism and medical science prompted a revival of interest in “the leprosy question,” its history has too often been written in purple prose of the most lurid kind. Over the last two decades, however, a number of authors have attempted to strip away cumulative layers of myth and supposition to gain a more accurate impression of responses to the disease. Having already contributed a clutch of important articles to the revisionist debate, Luke Demaitre has now produced a monograph which performs the rare feat of being both scholarly and compelling. As a much-needed corrective to the continuing obsession with marginality, sin, and exclusion, his study focuses on the medical profession and its long struggle to understand such a polymorphous and challenging disease. This was a far from academic problem, since physicians and surgeons were frequently commissioned by urban magistrates to conduct formal examinations, the outcomes of which would decide whether a suspect had to withdraw from society. As Demaitre points out, a positive diagnosis might confer eligibility for public support, which meant that many people actively sought to obtain one. Others fought hard to return home with a clean bill of health, and the book begins with some remarkable case studies through which the voices of the aggrieved and frightened suspects can still be heard.

With the meticulous precision of a physician conducting the judicium, Demaitre then guides us though the potentially confusing nomenclature employed by generations of experts and laypeople, the various definitions and explanations offered by medical authorities, and the development of ideas about contagion and heredity that were to flourish until the advent of microbiology. (Significantly, the Finnish physician, Isaac Uddman, who was a pupil of Linnaeus, suggested that the disease might be spread by invisible “animalcules” and thus anticipated Hansen’s findings by over a century.) We next turn to the fundamental questions of aetiology, diagnosis, prognosis, taxonomy, and treatment. The choice of period, which ranges from the thirteenth to the seventeenth centuries, with many allusions back to the work of Galen and his successors, transcends the customary divide between the medieval and early modern. This broad chronology affords an overview of the gradual, but by no means consistent, abandonment of the constraints of scholasticism and natural philosophy in favour of straightforward empirical observation. Yet, even when they had to contend with the orthodoxies of humoral theory, physicians always sought an explanation that was “intelligible, logical and open to analysis” (p. 184). Any lingering assumptions about the “backward” or “superstitious” nature of medieval medicine will surely be dispelled by Demaitre’s scrupulous research, which sweeps impressively across most of the European West. The omission of Great Britain (where practitioners were no less exercised about these matters but enjoyed only limited authority) does, however, preclude a more objective assessment of lay medical knowledge, which tends here to be judged from the unflattering perspective of the university.

It is a shame that the publisher could not find space for a bibliography or a short appendix of authors and their works, since medical historians and leprologists alike will surely wish to mine such a rich quarry. But this is not simply a work for a small cadre of specialists. It affords a fascinating insight into the legal and social structures within which the premodern medical profession was obliged to function, the hard-fought battle for recognition, and the internal rivalries that pitted surgeons against physicians. It is, most of all, a profoundly humane book, which demonstrates unequivocally that, for the practitioners described in its pages, leprosy was a physical disease to be studied as objectively as any other.