Hektoen International

A Journal of Medical Humanities

Complicating leprosy in the late medieval West

Juliana Menegakis
St. Andrews, Scotland

This unusual depiction of leprous priests is from an English copy of James le Palmer’s encyclopedia Omne Bonum (c. 1360-1375). MS Royal 6 E VI, vol. 2, fol. 301r, British Library.

Starting in the 1990s, Demaitre, Rawcliffe, and Touati revived the study of medieval leprosy, countering the traditional view that lepers were excluded from mainstream society.1 Traditionalists argued that medieval Europeans were inspired by Leviticus, which instructs priests on how to examine and cleanse people with a “defiling skin disease,” traditionally interpreted as leprosy. Leviticus concludes that as long as someone has this disease, they “remain unclean,” “must live alone,” and “must live outside the camp.”2 Most scholars today agree that leprosy increased dramatically during the twelfth century and was in decline by the fourteenth and fifteenth centuries. The foundation of leprosaria correspondingly surged during the twelfth century, with the earliest extant rule written in 1130.3

While “leper” is often considered a slur today, Rawcliffe has argued convincingly that the term was not a slur in the Middle Ages and allows us more insight into the medieval mind.4 Although lepers suffered stereotyping and a loss of legal rights, they were cared for in leprosaria and often viewed as God’s chosen, meaning that Hansen’s disease was ultimately no more debilitating than other physical conditions in the late medieval West.

Although leprosy was not understood as contagious until after most leprosaria were founded, the disease was still seen as a physical display of sin, giving lepers a liminal status separate from mainstream society. Protesting the traditional view that medieval lepers were feared because they were seen as contagious, Touati shows that the prevailing view from the second to fourteenth centuries was that leprosy was caused by an uncorrected humoral imbalance that eventually became permanent. According to Galen (the foundation of medieval medical thinking), it was only possible for leprosy to be spread from person to person if a body was already predisposed by a humoral imbalance. This meant that avoiding lepers was less important than maintaining humoral balance.5

Around 1220–1230, newly translated Arabic medical texts brought new ideas on contagion to the West, though aerial contamination remained at most a secondary cause of leprosy. For example, Bartholomaeus Anglicus wrote around 1240 in his De Proprietatibus Rerum that the primary cause of leprosy was humoral, with “putrid air” as one of several secondary causes.6 Theories of contagion did have some influence on rules in leprosaria, with the leprosarium at Brives imposing a rule in 1259 that forbade lepers from entering the chapel sanctuary to “prevent the spread of leprosy from sick residents to healthy staff members.”7 However, most leprosaria had already been built by this time, meaning that a desire to segregate “contagious” lepers could not have been the primary motivation for their construction. By the publication of Guy de Chauliac’s seminal 1363 treatise—the first to claim that leprosy was caused mainly by corrupted air and contact with lepers—leprosy was already on the decline.8 As Touati’s investigation demonstrates, contact with lepers was not as frightening as previous historians have argued. Instead, most leprosaria were built due to the understanding of leprosy as a physical reflection of sin.

Part of the complex religious understanding of leprosy was that the disease reflected internal sin. As Welch and Brown argue, leprosy was not just a medical condition, but a “socio-religious construct” that included the idea of lepers as terrifyingly lustful.9 In particular, Welch and Brown point out that loss of the nose (a common symptom of advanced leprosy) was a punishment for criminals and sexual sinners and made someone a “non-person” in the medieval mind. For men, it also meant stronger and more immoral lust, creating an association of leprosy with lechery.10 For example, in the popular twelfth-century Romance of Tristan, the leper Ivain says, “Sire, there is such lust in us that no woman on earth could tolerate intercourse with us for a single day.”11 This link between leprosy and sin often brought significant shame to sufferers. One example comes from Jean Bodel, who wrote a poignant poem in 1202 describing his grief and shame at leaving his community to enter a leprosarium. Bodel writes that “reason commands me to live a penitent life,” suggesting that his understanding of his disease as sinful led him to enter a leprosarium to repent. For example, he tells a friend that “shame and torment are driving me mad.”12 Bodel’s poem—one of very few to offer a first-person account of leprosy—provides some insight into the shame likely experienced by many lepers.13 Finally, the stigma associated with leprosy is shown in appeals to correct false diagnoses. For example, between 1487 and 1507, Jehan Jacquemin wrote to the Duke of Lorraine to ask him to intercede to correct his diagnosis. Taking such measures indicates that the consequences of his diagnosis must have been severe.14 Furthermore, this level of stigma persisting into the late fifteenth century, when leprosy had become less common, provokes speculation that the stigma may have been greater when the epidemic was at its peak. Overall, the stereotype of leprosy as sinful meant that medieval lepers typically experienced stigma and shame.

Though practical realities did not always match up to legislation, both clerical and lay lepers faced legal discrimination, such as demotions and segregation. As Dubourg explains, the expectation that clerics be physically perfect in imitatio Christi developed in canon law in the twelfth and thirteenth centuries. The 1234 Decretals of Gregory IX was the first major legal collection to assert this view, writing that a “physically altered man could not be a member of the clergy” because the sinful nature of their bodies prevented them from performing duties like blessing the sacraments.15 Similarly, Thomas Aquinas (d. 1274) wrote in his Summa Theologica that a leprous cleric should not perform Mass, both because they were physically incapable and because their frightening appearance might provoke horror—which prompted gossip, and thus scandal—in his congregation.16 Of course, Aquinas’s view might not have been followed, as social realities did not always follow legislation. However, the fact that a leprous cleric was theoretically barred from office shows that there was some level of legal discrimination against him.

Although it may be extreme to argue that they became “legally dead,” leprous laypeople also suffered legal discrimination. In 1179, the Third Lateran Council decreed that lepers should be allowed to have their own churches, priests, and cemeteries, as they could not live with the healthy or attend church alongside them. This policy mirrors the complex status of lepers, showing both “a policy of separation and isolation” and that lepers were given the tools of Christian salvation.17 As Miller and Nesbitt demonstrate, English, Norman, and German civic laws from the High Middle Ages onwards were more unequivocal, preventing lepers from suing in court, inheriting property, and making contracts. One key source for this is Henry of Bracton’s c. 1235 commentary on English common law. Henry concluded that lepers—like the insane, a group of people in many ways just as debilitated as lepers—could not sue in court, inherit property, or make contracts. According to Miller and Nesbitt, English law followed the example of Norman law, while northern German law followed the English example.18 Eichbauer summarizes Miller and Nesbitt’s stance aptly: “Like minor children and the insane, [lepers] had no to recourse to legal actions. The leper was legally dead.”19 However, it is worth noting that some areas of the West did not have such restrictive laws against lepers. For example, Francoise Bériac shows that southern French lepers made contracts, sold property, and made wills, just like healthy people. In contrast, Miller and Nesbitt point out that France also saw lepers driven from their homes by secular lords and church officials, even when there was no legal requirement for their isolation.20 As this reminds us, reality did not always match up with legislation, whether clerical or civic.

Although they faced debilitating legislation, leprous clerics were typically given relative social inclusion by the papal chancery. For example, Eichbauer argues that canonists discussing the issue of whether leprous priests should be defrocked also emphasized the importance of caring for them.21 In many cases, a coadjutor was appointed to carry out the duties of a leprous priest, though the priest was usually responsible for paying the coadjutor out of his salary.22 When one rector developed leprosy in 1256, he was given a pension by the pope, though he was forced to live in total isolation. In 1349, the pope gave a dispensation allowing a leprous Cistercian monk to live in a separate building, contravening the order’s usual requirement to live together. These cases illustrate that papal dispensations were a consistently important way that leprous clerics received care. However, they also show that these clerics were frequently isolated. To avoid this, some leprous clerics chose to join a leprosarium instead, indicating that leprosaria were regarded by some as places of community, not prisons.23

Much like their clerical counterparts, laypeople in leprosaria were usually provided with a range of secular benefits, such as high-quality physical care and communal support. As Brenner explains, most leprosaria offered bodily treatment that followed contemporary medical theories of the four humors, such as bloodletting and specific food. For example, the leprosarium of Salle-aux-Puelles outside Rouen allowed residents to choose to receive bloodletting in its 1249 ordinances.24 This demonstrates not only the provision of physical care, but also some level of autonomy, supporting Brenner and Touati’s conclusion that while leprosaria generally meant segregation from most of society, they were often supportive and caring communities.25 The provision of care in leprosaria is also a notable contrast to many other groups. As Turner notes, “for many disabled or impaired persons, little assistance was available outside their family or community.”26 Furthermore, Miller and Nesbitt explain that lepers typically had significant input in the governance of their leprosarium. In many leprosaria, the lepers elected their master, who often had to be a leper. Most leprosaria also forced residents who broke the rules to leave, showing that they were not prisons.27

In addition to physical care, leprosaria emphasized the unique status of lepers as spiritual elites—a status not shared by most other disabled groups in the Middle Ages. As Touati has shown, leprosy was not seen as contagious. Instead, it was understood as God urging sinners to do penance, creating a link between leprosy and redemption.28 Many people agreed that lepers had been chosen by God to suffer on Earth, which would allow them to gain salvation sooner. This led theologians like Jacques de Vitry (d. 1240) to argue that lepers were spiritually superior to other laypeople.29 De Vitry wrote that lepers who focused on their spirituality would definitely go to Heaven, as their penitential suffering had already been completed on Earth.30 This idea that leprosy allowed people to achieve redemption sooner created the view that it was a gift from God. For example, Bernard de Clairvaux (d. 1175) called chronic disease “a divine gift, pregnant with opportunity.”31 Similarly, Humbert of Romans (d. 1277) wrote that some sinful lepers “abuse the discipline which God grants them.”32 This reference to discipline shows Humbert’s view that leprosy was a God-given opportunity for repentance, reflecting the idea that individual lepers were responsible for their own salvation and could seize or squander the gift God had given them.33

The focus on leprosaria as places of redemption led to the expectation that residents live like monks, including following the monastic virtues of personal poverty, obedience, and chastity. Indeed, the cleric Robert of Flamborough (writing c. 1210) classed lepers in leprosaria alongside monks as members of religious orders.34 As Brenner points out, strict monastic rules were enforced to establish a high standard of piety and penance for the leprous residents, which would ensure their salvation as the chosen of God.35 As such, lepers in a leprosarium were in a liminal state, removed from their former lives but in earthly purgatory before entering Heaven. This parallels Dubourg’s argument that a leprous cleric attained a new social status between clergy and laity.36 This privileged spiritual status was also relatively unique among medieval disabled people, who were usually assigned physical causes of their ailments. As Metzler argues, disability was not uniformly seen as a result of sin, but the association of other disabilities with sacred suffering was not as established as it was for leprosy.37 Lepers were ultimately seen as containing the capacity for both sin and sanctity, meaning that they were not fully debilitated.

Lepers in the late medieval West undoubtedly faced the stereotype that they were full of sin, most commonly lust. Lepers in many regions also faced legal discrimination akin to “legal death,” while leprous clerics might be defrocked. However, leprosaria were often places of compassion and physical care, as well as liminal spaces that allowed lepers to endure the sacred suffering that would lead them to Heaven. Ultimately, lepers were not significantly more debilitated than other people with bodily impairments in the late medieval West.

End notes

  1. Elma Brenner, “Recent Perspectives on Leprosy in Medieval Western Europe,” History Compass 8, no. 5 (2010): 388.
  2. Lev. 13:2, 46 (New International Version). See also Harry Goldin, “Biblical Leprosy: A Dermatologist’s Perspective,” Hektoen International 15 (Summer 2023).
  3. Timothy S. Miller and John W. Nesbitt, Walking Corpses: Leprosy in Byzantium and the Medieval West (Ithaca: Cornell University Press, 2014), 121, 125-6; Elma Brenner and François-Olivier Touati, “Introduction,” in Leprosy and Identity in the Middle Ages: From England to the Mediterranean, ed. Elma Brenner and François-Olivier Touati (Manchester: Manchester University Press, 2021), 4.
  4. Brenner, “Recent Perspectives,” 389.
  5. François-Olivier Touati, “Contagion and Leprosy: Myths, Ideas and Evolution in Medieval Minds and Societies,” in Contagion: Perspectives from Pre-Modern Societies, ed. Lawrence I. Conrad and Dominik Wujastyk (Aldershot: Ashgate, 2000), 185-8, 191.
  6. Touati, “Contagion and Leprosy,” 192-3, 196.
  7. Miller and Nesbitt, Walking Corpses, 112.
  8. Touati, “Contagion and Leprosy,” 196-8; Brenner and Touati, “Introduction,” 4.
  9. Christina Welch and Rohan Brown, “From Villainous Letch and Sinful Outcast, to ‘Especially Beloved of God’: Complicating the Medieval Leper through Gender and Social Status,” Historical Reflections 42, no. 1 (2016): 49.
  10. Welch and Brown, “From Villainous Letch,” 51-3.
  11. Beroul, The Romance of Tristan, trans. Alan S. Fredrick (London: Penguin, 1970), 27.
  12. Jennifer Stemmle, “From Cure to Care: Indignation, Assistance and Leprosy in the High Middle Ages,” in Experiences of Charity, 1250-1650, ed. Anne M. Scott (Aldershot: Ashgate, 2015), 60-1.
  13. Stemmle, “From Cure to Care,” 60-1.
  14. Elma Brenner, “Between Palliative Care and Curing the Soul: Medical and Religious Responses to Leprosy in France and England, c. 1100–c. 1500,” in Medicine, Religion and Gender in Medieval Culture, ed. Naoe Kukita Yoshikawa (Cambridge: D. S. Brewer, 2015), 230-1.
  15. Ninon Dubourg, “Clerical Leprosy and the Ecclesiastical Office: Dis/Ability and Canon Law,” in New Approaches to Disease, Disability, and Medicine in Medieval Europe, ed. Erin Connelly and Stefanie Künzel (Oxford: Archaeopress Archaeology, 2018), 65.
  16. Dubourg, “Clerical Leprosy,” 67-8.
  17. Melodie H. Eichbauer, “Legal Authorities and their Legislative Priorities: The Treatment of Leprosy in the Sources of Canon Law,” Zeitschrift der Savigny-Rechtsgeschichte: Kanonistische Abteilung 106, no. 1 (2020): 156.
  18. Miller and Nesbitt, Walking Corpses, 108; Eichbauer, “Legal Authorities,” 157.
  19. Eichbauer, “Legal Authorities,” 157.
  20. Miller and Nesbitt, Walking Corpses, 109-110, 115.
  21. Eichbauer, “Legal Authorities,” 187.
  22. Dubourg, “Clerical Leprosy,” 64; Irina Metzler, A Social History of Disability in the Middle Ages: Cultural Considerations of Physical Impairment (New York: Routledge, 2013), 143.
  23. Dubourg, “Clerical Leprosy,” 70-4.
  24. Brenner, “Between Palliative Care,” 231-2.
  25. Brenner and Touati, “Introduction,” 12.
  26. Wendy J. Turner, “Introduction,” in Madness in Medieval Law and Custom, ed. Wendy J. Turner (Leiden: Brill, 2010), 9.
  27. Miller and Nesbitt, Walking Corpses, 132, 135-7, 126.
  28. Brenner, “Between Palliative Care,” 224.
  29. Brenner, “Recent Perspectives,” 392-3.
  30. Welch and Brown, “From Villainous Letch,” 55.
  31. Welch and Brown, “From Villainous Letch,” 55-6.
  32. Humbert of Romans, “To the Leprous,” in Other Middle Ages: Witnesses at the Margins of Medieval Society, ed. Michael Goodich (Philadelphia: University of Pennsylvania Press, 1998), 147.
  33. Humbert, “To the Leprous,” 147-8.
  34. Miller and Nesbitt, Walking Corpses, 125-8.
  35. Brenner, “Between Palliative Care,” 234-5.
  36. Dubourg, “Clerical Leprosy,” 75.
  37. Metzler, A Social History, 203-4.

JULIANA MENEGAKIS is a third-year student studying history at the University of St. Andrews, Scotland.

Winter 2025

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