The most persistent stereotypes about medieval leprosy are being challenged, by both evidence and arguments, in the steadily growing body of Professor Touati’s writings. The Archives, a model for future inventories of leper communities, guarantee that his foundation for a revised history of leprosy is solid. The significance of his work is enhanced by its focus on “la France essentielle” (p. 22): the ecclesiastical province of Sens, consisting of eight dioceses, which was probably the most populous region in Europe, with an estimated 1.5 million inhabitants around 1300. In addition to Paris, it included important cities such as Chartres, Orleans, and Troyes.
The census of 395 leper houses suggests, first of all, that chronological perspectives need to be adjusted. The early date of the first foundations, well before 1100, argues against focusing on the role of the Crusades in the spread of the disease. Moreover, the greatest number of settlements were founded right in the twelfth century and its “renaissance,” rather than between 1150 and 1250 as is generally assumed. Touati sees their impetus in the same overflow of population and social dynamics that led to fairs, new towns, pilgrimages, monastic reform, and so on. He also argues that attributing the phenomenon of leprosaria to waves [End Page 108] of leprosy is hardly more logical than explaining the contemporaneous rise of hospitals (or, for that matter, medical faculties) by a surge in morbidity. Far from springing up or proliferating haphazardly, leper houses were “founded” in successive stages, distributed systematically, and modified in response to various circumstances that had little to do with epidemiology. Overestimations of the endemic are deflated by the tallies of the Archives, which yield only one leper house per nine or ten parishes. The average number of residents was small: fewer than a dozen people, of whom, even more surprisingly, a minority were actual patients. Hence, Touati estimates that the ratio of lepers per population never exceeded a level of 5 to 8 per thousand, considerably below the 11 to 50 per thousand in today’s most affected regions.
The stereotype of exclusion as the universal fate of lepers is contradicted by the stated objectives for housing them. Inclusion was the norm in measures to ensure order—for example, by providing a hostel for “people who suffer from the said disease of leprosy and who are vagrants and beggars” (p. 297). However pervasive the fear of leprosy may have been, it was charity that motivated the founders of leprosaria—often with ulterior interests ranging from public relations to eternal rewards. One donation was expressly given “to the blessed poor who are called lazars” (p. 300), and no fewer than seventeen leper communities received bequests from Adam, a royal chef (p. 36). The biblical injunction to “eject every leper from the towns” (Num. 5:2–4) was invoked rarely, and then not as a premise but as an ecclesiastical justification post factum. The leprosarium was not characterized as a place of confinement and oblivion but as a house, “domus,” or a lowly cottage, “bordellum.” It also figured as a religious shrine, “capella”—or, in the most striking instance, “monasterium leprosorum,” consecrated by Bishop Ivo of Chartres around 1100. More mundanely, it was a center of agricultural production and revenue, “grangia.” The selection of a site was governed by concerns other than the fear of contagion. Map after map in the Archives shows virtually all leper houses located in places of intense traffic, at the confluence of roads or rivers, and within less than an hour’s walking from bustling towns.
The rich context of medieval life may be glimpsed in the Archives, in which wills, royal registers, chronicles, and other documents are cited but not quoted. References to cartularies and visitation reports offer only tantalizing tidbits of information about the incidence and treatment of leprosy. A revealing silence, however, lies in the virtual...