Leprosy and Charity in Medieval Rouen by Elma Brenner (review)

Elma Brenner brings a timely, though unintended, rejoinder to a monograph that perpetuated lurid images of lepers and selectively disparaged medieval Western European responses to leprosy as contrasting with the charitable exhortations and institutions in Byzantium.¹ Leprosy and Charity in Medieval Rouen represents a refreshingly positive outlook, although the author reminds us that responses were too “diverse and fluctuating” to fit simplification (108), even when the “fashion for Christian charity” peaked in the 13^th century (38). Her study extends the trails blazed recently by historians, most notably Carole Rawcliffe and François-Olivier Touati, who discredited the negative stereotypes. Her contribution has the additional merit of focusing on the region of historic interaction between Rawcliffe’s England and Touati’s France.

Brenner documents a wide range of aid to lepers, from bequests by founders to care by attendants; from aristocratic patronage to bourgeois beneficence; from impromptu almsgiving to annual revenue; from money to provisions; and from confraternity campaigns to authority endorsements. This range is integral to the contextualization of medicine. A crucial aspect of the medieval context is the function of hospitals as shelters, with custodial care as primary concern rather than treatment and recovery as in their modern counterparts. Foundations were motivated as much by devotion as by philanthropy, with special spiritual rewards promised by the prayers and sufferings of leprous beneficiaries. This incentive underlay the imposition of religious rules and, for eight leper houses around Rouen, affiliation with a monastic establishment.

The priority of eternity over earthly life, reflected in religious discipline, did not mean indifference to health. The statutes show that devotional obligations took into account the physical conditions of the sick. The well-being of patients was accommodated in the management of their surroundings and diet, even allowing for the bloodlettings that were essential in humoral medicine. Able-bodied lepers assisted religious and lay residents in tending to the bedridden. There are no records of attendance by professional practitioners in Rouen leper houses. As Brenner proposes, their invisibility may suggest that they “avoided practicing in leprosaria” for several reasons, including the view that the patients “had no hope of recovery” (92). This issue invites further thought, but it is worth observing that Brenner does not mention fear of contagion among the reasons.

Leprosy and Charity in Medieval Rouen stands out by its judicious treatment of the widely misunderstood relation between leprosy and contagion. The author emphasizes three critical premises: that the medieval notions of contagion were imprecise and varying; that concerns with contagiousness fluctuated, with a marked increase after the Black Death; and that segregation could be driven by other factors, such as “the shocking physical appearance” (81). There is ample argument for reservations about the role of contagion, given the interaction between sick and healthy residents, the proximity of leprosaria to the city gates, regular contact with suppliers, and even frequent visits without permission. Furthermore, while only a portion of lepers were isolated in endowed institutions, those who remained at large encountered less drastic measures than they would have in a society with a modern understanding of contagion. Outsiders seem to have received “temporary shelter” at Rouen’s major leprosarium (55–6). This possibility adds an intriguing dimension to our fragmentary information about itinerant lepers before they became part of the wider threat of vagrancy. The scattered data from various regions await collation that, in turn, should contribute to a better perspective on medieval contagion.

The principal leper house in Rouen, Mont-aux-Malades, was settled before 1100. The size of the community reached its height between 1258 and 1264, when it grew from 61 to 70 members. It is of interest to note that the number of lepers in this community declined from 34 (15 female, 19 male) to 29 (17 female, 12 male), while the proportion of non-leprous residents rose from 44 percent to 58 percent. These proportions suggest that Mont-aux-Malades may also have served as a refuge to healthy burgesses...