Medieval leprosy

Resumo
Este estudo tem por objetivo dar a conhecer o modo como o Homem medieval enfrentou os desafios que se colocavam à sua saúde e bem-estar na cidade e região de Coimbra, nos finais da Idade Média. Começamos por descrever alguns dos tratamentos e cuidados dispensados aos doentes no meio urbano e social onde estavam integrados, focando-nos depois na assistência prestada aos enfermos nos hospitais de Coimbra e de Montemor-o-Velho. Por fim, centraremos a nossa atenção nas medidas de controlo de doenças contagiosas, como a lepra, e de surtos de peste, adotadas pelos poderes civis. **//**
Abstract
The goal of this article is to analyse how the medieval Man faced the challenges to his health and wellbeing in the late medieval Coimbra city and region. We start to describe the treatment and care given to the sick in their urban and social environment, focusing on those provided in Coimbra and Montemor-o-Velho hospitals. Finally, we will examine the measures taken by civil authorities to control plague outbreaks and other contagious diseases, like leprosy.

The cagots were a poorly understood marginalised group found on both sides of the western Pyrenees. They started to become prominent from the thirteenth century before largely disappearing in the twentieth century. This paper describes a curious incident in Biarritz in 1721. To explain what happened, it gallops over 500 years of history to examine the reasons cagots faced discrimination. In doing so it considers the ambiguity of medieval leprosy, the rise of the persecuting society, changing attitudes to poverty, defiled trades, the birth of racism, Jews and violence, Gypsies and assimilation, honour and pollution and conflict between communities and the state.

Im Mittelalter und in der frühen Neuzeit war die Lepra eine weit verbreitete Krankheit. Leprosorien dienten zur speziellen Unterbringung der Leprakranken. In den Rheinlanden können von der ersten urkundlichen Erwähnung eines Leprosoriums im Jahre 1180 bis zum Aussterben der Lepra im 18. Jahrhundert insgesamt 190 Leprosorien dokumentiert werden. Die Untersuchung widmet sich Fragen zum wirtschaftlichen, sozialen und organisatorischen Entwicklungsstand dieser Einrichtungen. Außerdem stehen die Lebensgewohnheiten der Leprakranken im Fokus sowie ihre rechtliche und soziale Stellung. Schließlich wird der Frage nach dem Rückgang der Lepraerkrankungen und dem endgültigen Verschwinden der Krankheit zu Beginn des 18. Jahrhunderts nachgegangen. Vor allem die Folgen des Rückgangs werden genauer beleuchtet, zunächst Unterbelegung, dann Verfall, Auflösung oder Zweckentfremdung von Leprosorien. Zur Analyse der Ergebnisse in ihrem Raumbezug dient eine großformatige Karte, die ein zeitlich differenziertes Bild der Leprosorien in den Rheinlanden zwischen dem 12. und 18. Jahrhundert ermöglicht. Vier weitere Karten verdeutlichen raumbezogene Einzelaspekte.
Rezensionen: Vierteljahrschrift für Sozial- und Wirtschaftsgeschichte 100 (2013), S. 94 ; Hémecht 65 (2013), S. 120-122; Rheinische Vierteljahrsblätter 77 (2013), S. 363; Deutsches Archiv für die Erforschung des Mittelalters 69,1 (2013), S. 429-430; Zeitschrift für die Geschichte des Oberrheins 161 (Neue Folge 122) (2013), S. 678-679; Revue historique 668 (2013), S. 958-959; Zeitschrift für Historische Forschung 41 (2014), S. 133-135.

This was published online as Monica H. Green, “Climate and Disease in Medieval Eurasia,” Oxford Research Encyclopedia of Asian History, ed. David Ludden (New York: Oxford University Press, 2018), DOI: 10.1093/acrefore/9780190277727.013.6. The essay offers the first pan-Eurasian survey of the histories of malaria (Plasmodium vivax and P. falciparum), leprosy (Mycobacterium leprae and M. lepromatosis), smallpox (Variola major), and plague (Yersinia pestis) that incorporates the latest findings from genetics, bioarchaeology, and documentary history. It is intended as an interdisciplinary reference to help researchers in the sciences and humanities connect with the latest trends in the field. ---
For nearly two years, this essay was behind the publisher's paywall. As on November 2020, it has again been made open-access, at this link: https://oxfordre.com/asianhistory/view/10.1093/acrefore/9780190277727.001.0001/acrefore-9780190277727-e-6. If you have questions, please contact me directly at: monica.h.green@gmail.com.

Este libro es un ejercicio de síntesis histórica que analiza las instituciones hospitalarias de todo Aragón durante cuatrocientos años. Para ello ha utilizado un corpus documental heterogéneo de variados archivos estatales, provinciales, eclesiásticos o municipales. La obra se compone de dos partes. En la primera se define el concepto de hospital y se presentan los agentes que intervinieron en su desarrollo de forma activa (promotores y trabajadores) y de forma pasiva (pobres y miserables). La segunda parte consiste en un estado de la cuestión sobre el fenómeno hospitalario en cada una de las regiones aragonesas del Aragón medieval, incluyendo tanto el mundo urbano como el rural.

A middle adult male skeleton from the medieval period , C58, excavated from the cemetery of the St James and St Mary Magdalene Hospital in Chichester has been analysed osteologically and  palaeopathologically.  C58 exhibits a congenital syndrome involving shortness of the forelimbs, decreased stature and is diagnosed with lepromatous leprosy.  Its inclusion at the leporsorium may been contributed to the development of leprosy in C58 rather than as a result of the condition.

Op een steenworp afstand van de stadsmuren van het middeleeuwse Haarlem lag een klein ziekenhuisje voor de leprozen van de stad. Deze leprozerie ontstond in de late middeleeuwen, tijdens de periode van ur- banisatie en voorspoed in het graafschap Holland. Waarom werd dit le- prooshuis toen gebouwd en waarom buiten de stad? Een historische ver- kenning van dit laatmiddeleeuwse instituut, haar zieke inwoners en de bijzondere positie die het had in de samenleving van Haarlem.

Este artigo tem por objetivo demonstrar de que modo a sociedade conimbricense praticou a primeira das obras de misericórdia corporais: Dar de comer a quem tem fome”. Pretendemos apresentar como se proveu o sustento alimentar dos pobres e doentes, na cidade de Coimbra, ao longo da Idade Média, e como, dessa forma, se cuidou de corpos fragilizados tanto pela miséria, como pela doença. Primeiro, no contexto de desenvolvimento da designada “economia da salvação”, analisaremos os legados testamentários compostos por géneros alimentares ou quantias em dinheiro destinadas a comprar estes produtos para os pobres. Neste sentido, é nosso objetivo verificar que alimentos compunham esses legados, para perceber quais os mais frequentemente repartidos pelos indigentes e enfermos da cidade, e analisar como se distribuíam ao longo do calendário. Num segundo momento, centraremos a nossa atenção no provimento alimentar oferecido pelas confrarias e hospitais de Coimbra, responsáveis por acolher pobres e doentes, que aqui encontravam condições básicas de sobrevivência. Destacaremos o Hospital de Santa Isabel e o Hospital de
S. Lázaro, para os quais se conhecem as rações individuais distribuídas a partir de 1328 e 1329, respetivamente.

This paper aims to analyse how the first corporal work of mercy, “To feed the hungry”, was practiced by the Coimbra’s society. We intend to present the way the poor and the sick were fed in the medieval city of Coimbra, and also how their bodies weakened by poverty and disease were care. First, in the context of the development of the “economy of salvation”, we’ll analyse the testamentary donations to the poor of food or the money to buy it. Thus, it’s our purpose to confirm how these legacies were comprised, to understand which food was most often given to the city’s poor and sick and the alms distribution framework along the calendar. Secondly, we’ll focus in the food offered by Coimbra confraternities and hospitals, which provided basic survival conditions to the poor and sick. We’ll emphasize the examples of Saint Elisabeth and Saint Lazarus hospitals, for which we know the individual provisions distributed since 1328 and 1329, respectively.

Plague and leprosy have left deep traces in the collective memory of Central Europe more
than other diseases and epidemics. The paper examines how medieval and early modern
societies reacted to the threat of the epidemics and which methods were used to understand and categorise the fateful and inexplicable experiences with these diseases. Particular attention is given to the iconographic forms of representation of plague and leprosy, showing a particular significance in social perception until today. Recent examples from literature, newspapers, movies and computer games illustrate this relationship. It becomes clear that the aesthetic dimensions of contemporary depictions of disease, in contrast to written sources, offer a deeper and more significant insight into the origins of the leprosy and plague motifs that are still effective to the present day.

This study offers a corrected interpretation of a widely disseminated image, said to depict plague at the time of the Black Death but actually a representation of leprosy. It includes a full transcription and translation of the section of the text the image was originally meant to illustrate: James le Palmer, *Omne bonum*, cap. "De clerico debilitato ministrante sequitur videre" (On Ministration by a Disabled Cleric), London, British Library, Royal 6 E. VI, vol. 2, fols. 301rb–302ra. This essay, and all essays in this special inaugural issue of *The Medieval Globe*, are available OPEN-ACCESS at the following link: http://scholarworks.wmich.edu/medieval_globe/1/.

For a follow-up on how this misdiagnosed image was taken down from plague websites all over the Internet in subsequent months, see this March 1, 2015, blog post by Lori Jones: http://arc-medieval.blogspot.com/2015/03/getting-words-out-and-back-in-what-to.html. For further examples about the misuse of images in infectious disease history, see Lori Jones and Richard Nevell, "Plagued by doubt and viral misinformation: the need for evidence-based use of historical disease images," Lancet Infectious Diseases 16, no. 10 (October 01, 2016),  e235-e240, https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30119-0/fulltext.

http://www.public.asu.edu/~mhgreen/healthanddisease2012/index.html
“Health and Disease in the Middle Ages” was a five-week Seminar for College and University Teachers held June 24-July 28, 2012, in London, England. Based at the Wellcome Library—the world's premier research center for medical history—this Seminar gathered scholars from across the disciplines interested in questions of health, disease, and disability in medieval Europe. Support for this Seminar came from the National Endowment for the Humanities (NEH) and the Arizona Center for Medieval and Renaissance Studies (ACMRS).

We explored how the new scientific technologies of identifying pathogens (particularly leprosy and plague) could inform traditional, humanistic methods (historical, literary, art historical, and linguistic) of understanding cultural responses to disease and disability. Reciprocally, we also explored how traditional, humanistic studies of medieval medicine could inform modern scientific studies of disease, which were developing at a rapid pace thanks to new methods of DNA retrieval and analysis.

Special emphasis wasmplaced on assisting participants with independent research projects relating to the History of Medicine, especially—but not restricted to—those based on unpublished primary sources.

Jeanne D., Chapelain de Seréville-Niel C., Blondiau J., Truc M.-C. et al. 2021, « Les soins des lépreux au Moyen Âge : approche transdisciplinaire de la fouille à l’histoire du site de Saint-Thomas d’Aizier (XIIe-XVIe s.) », in Kacki S., Réveillas H., Knüsel C., Rencontre autour du corps malade. Prise en charge et traitement funéraire des individus souffrants à travers les siècles. Actes de la 10 Rencontre du GAAF, Bordeaux, 23-25 mai 2018 (Publication du Gaaf n°10), p. 85-96.

In 2009, an archaeological intervention in the Valle da Gafaria (Lagos, Portugal) allowed the excavation of part of a leprosarium and an associated necropolis (15the17th centuries). The individuals recovered were buried directly in the soil, in positions and orientations discordant to the prevailing Christian rules. The sample is made up of eleven adult individuals of both sexes.
This paper discusses the differential diagnosis of unusual and distinct pathological changes in five of the individuals recovered. The differential diagnosis of the lesions gave rise to several possible patho- logical conditions, namely, leprosy, treponematosis, brucellosis, slipped femoral capital epiphysis, and Legg-Calvé-Perthes disease. Various macroscopic and radiological aspects led us to consider leprosy as the most probable diagnosis in two individuals. Treponematosis and brucellosis were the probable diagnosis in other two individuals, respectively. One individual presented lesions in the right femur compatible with Legg-Calvé-Perthes disease.
Historical documents suggest that the poor, mentally disabled, and people suffering from syphilis, tuberculosis, among others, were also housed in leprosaria. Therefore, it is possible that evidence of other conditions is found in human remains uncovered at a leprosarium.
The cases under study enrich the scanty osteoarchaeological documentation of palaeopathology in Portugal in the Modern Age, namely of leprosy, brucellosis, treponematosis, and Legg-Calvé-Perthes disease, and they can contribute to reduce the discrepancy between historical and biological evidences of disease.

William of Saint-Pathus’ hagiography of Saint Louis, written approximately 30 years after his death, used as its source the documents from the canonisation commission. The fragments of documents that remain from the commission suggest that Saint-Pathus’ record of Saint Louis’ behaviour and his miracles is highly accurate. The format of the hagiography was identical to the Life of Saint Francis written by Saint Bonaventure. This paper examines in particular the detailed account of Saint Louis’s meeting with a leprous monk at the royal abbey of Royaumont. The encounter involved Saint Louis kneeling in front of the leper and feeding him freshly cooked food with his own hands. Saint-Pathus also recorded Saint Louis wiping the blood from the sores and wounds of other sick people. There are clear parallels to be drawn between the deeds of Saint Louis and those of Saint Francis, especially with regard to compassion towards the sick. The portrayal by Saint-Pathus, the Franciscan confessor of Saint Louis’ widow, forms part of the construction of image of Saint Louis as a holy king devoted to the mendicant orders, whose deeds were in turn adopted by the Franciscan order as a model of exemplary conduct towards the sick and the poor.

In April 2021 the online workshop Methodius von Olympus’ Schrift De lepra als Exempel für die Gesamtedition des Corpus Methodianum – Interdisziplinäre Zugänge was held at the University of Jena. The Greek text of the De lepra is only known through a long fragment preserved in the so-called Florilegium Coislinianum, a Byzantine spiritual anthology compiled in the 9th or 10th c. most probably in Southern Italy. In my paper I described the main features of the Florilegium and discussed the five known manuscripts relevant for the edition of the De lepra. This document offers an upgraded version of my talk which is the manuscript I submitted to the Workshop proceedings.

Este artigo tem como objetivo compreender algumas das componentes que caracterizaram a Casa de São Lázaro de Lisboa, uma instituição destinada a acolher indivíduos que padeciam de lepra, no alvorecer da modernidade. Focaremos, em primeiro lugar, os aspetos relacionados com a organização da instituição, nomeadamente ao nível dos seus oficiais e funcionários, do património e rendimentos que tinha à sua disposição e dos espaços que a compunham. Em segundo lugar, analisaremos aspetos administrativos, acompanhando alguns dos episódios que marcaram as disputas jurisdicionais pelo controlo da administração da gafaria. Por fim, avançaremos as conclusões possíveis sobre os enfermos que habitavam a leprosaria e sobre a sua vivência na instituição.

Humans are constantly at risk of bone fractures, not only when threatened by personal violence, but also by the challenge of daily living. Because fractures are a cross-cultural phenomenon and are one of the more commonly observed skeletal lesions in archaeological collections, their presence provides a unique opportunity to compare living conditions, and thereby assess fracture risk in coexisting cultures. This study analyzed long bone fracture patterns of 212 sexed adults from the medieval leper hospital of St. James and St. Mary Magdalene in Chichester, England. The comparison of this hospital sample to other British medieval skeletal samples examined the level of health manifest in fracture etiology. The fracture frequency for this sample was 15.1%, with males accounting for 85.4% of the fractures. The fracture frequencies from the samples not affiliated with hospitals ranged from 3.3 to 5.6%. Because medieval urban lifestyle was notoriously difficult due to inadequate sanitation and living conditions, the overall health of the population at large was inferior, placing all at similar fracture risk. Therefore, more specific complications associated with the fractures were examined. Osseous modifications of the skeletons due to lepromatous leprosy were associated with 28% of individuals sustaining fractures. However, persons with the milder tuberculoid leprosy do not exhibit skeletal lesions, but are more prone to accident due to the earlier loss of sensory perception and visual impairment. It is argued that the presence of leprosy is underestimated in archaeological populations and may be a major contributing factor to the prevalence of fracture resulting from accidental falls.

Das Ziel der Untersuchung ist die Erfassung aller Leprosorien in den Rheinlanden und die Analyse der sich vom Mittelalter bis in die frühe Neuzeit erstreckenden Entwicklungslinien. Als Leprosorien oder Siechenhäuser werden hierbei alle Anstalten definiert, die speziell der Unterbringung Leprakranker gedient haben. Ihre Darstellung erfolgt auf der Grundlage der OH-Karte im Maßstab 1:500.000. In diesem Kartenausschnitt konnten für den Untersuchungszeitraum, der sich von der ersten urkundlichen Erwähnung eines Siechen-hauses im Jahre 1180 bis zur Schließung der letzten Einrichtungen am Ende des 18. Jahrhunderts erstreckt, insgesamt 164 Leprosorien nachgewiesen werden. Da für keine dieser Ein-richtungen ein Gründungsbeleg überliefert ist, werden sie entsprechend ihrem urkundlichen Erstbeleg nach drei Zeitstufen differenziert. Als erster Zeitschnitt wurde das Jahr 1350 wegen der dramatischen Reduzierung der Bevölkerungszahl in Folge des Pestzuges von 1348-1350 festgelegt. Der zweite Zeitschnitt wurde für das Jahr 1550 vorgenommen, weil ab der Mitte des 16. Jahrhunderts der endgültige Rückgang der Lepra einsetzte. Für die Siechenhäuser ohne einen Erstbeleg wurde gemeinsam mit den Leprosorien, deren Existenz nicht zweifels-frei nachgewiesen werden konnte, eine vierte "Zeitstufe" ergänzt. Die Kennzeichnung der Einrichtungen wird durch eine Kreissignatur vorgenommen; beschriftet werden sie mit dem Ortsnamen. Eine Unterscheidung erfolgt durch die im Atlas-Unternehmen zur Kennzeichnung der zeitlichen Abfolge von alt zu jung verbindliche Farbskala von dunkel zu hell:
– Erstbeleg bis 1350 => violett
– Erstbeleg zwischen 1351 und 1550 => rot
– Erstbeleg zwischen 1551 und 1800 => grün
– Existenz ungesichert bzw. keine zeitliche Einordnung möglich => grau
Als problematisch erwies sich das breite Spektrum der als Leprosorien zu bezeichnenden Einrichtungen; es reicht von der einfachen Hütte eines Feldsiechen bis hin zu wirtschaftlichen "Großbetrieben" – wie beispielsweise Köln–Melaten – mit speziellen Verwaltern oder Proviso¬ren, Dienstpersonal, eigener Kapelle, für eine dauerhafte Nutzung gebauten Häusern und mitunter beachtlichem Vermögen. Durch die Erarbeitung und Zusammenstellung der acht wichtigsten Kriterien einer voll ausgebildeten Anlage wird der Idealtypus eines rheinischen Leprosoriums umrissen. An diesem Idealtypus können dann die in Größe und Ausstattung stark variierenden Siechenhäuser in ihrer Bedeutung gemessen werden. In der Hauptkarte werden die wichtigsten "Standortfaktoren" sowie die für die Größe und Bedeutung eines Siechenhauses entscheidenden Kriterien der Organisationsformen verzeichnet. Die Darstellung der einzelnen Kriterien (Kapelle, Hagioskop, Seelsorge, Friedhof, Leprosenordnung, Provisoren, Lepraschau, Leprosenbruderschaft, Hochgerichtsstätte, Schellenknecht und Siechennachen) erfolgt durch Piktogramme.
Der Katalog ist nach Ortsnamen alphabetisch geordnet. Er enthält in folgender Reihung Informationen zu den Siechenhäusern: Bezeichnung, topographische Lage, urkundliche Ersterwähnung, Gebäude, Kapelle, Hagioskop, Seelsorge, Hinrichtungsstätte, Insassen, Verwaltung, Stiftungen und Schenkungen sowie Einkünfte und Besitz, Leprosenordnung, Lepraschau, Leprosenbruderschaft, Schließung.