Some have refused to see in such cases any real correspondence with the modern forms of syphilis because only local effects are described and no constitutional consequences traced. But no one in those times thought of a primary focus of infection with its remoter effects at large, in the case of any disease whatsoever. Even in the great epidemic of syphilis at the end of the fifteenth century, the sequence of primary and secondary (tertiaries were unheard of until long after), was not at first understood; the eruption of the skin, which was compared to a bad kind of variola, the imposthumes of the head and of the bones elsewhere, together with all other constitutional or general symptoms, were traced, in good faith, to a disordered liver, an organ which was chosen on theoretical grounds as the minera morbi or laboratory of the disease[147]. The circumstances of the great epidemic were, of course, special, but they were not altogether new. No medieval miracle could have been more of a suspension of the order of nature than that luxuria, immunditia, and foeditas, with their attendant corruptio membrorum, should have been free from those consequences, in the individual and in the community, which are more familiar in our own not less clean-living days merely because the sequence of events is better understood. That such vices abounded in the medieval world we have sufficient evidence. They were notorious among the Norman conquerors of England, especially notorious in the reign of William Rufus[148]; hence, perhaps, the significance of the phrase lepra Normannorum. That particular vice which amounts to a felony was the subject of the sixth charge (unproved) in the indictment of the order of the Templars before the Pope Clement V. in 1307. Effects on the public health traceable to such causes, for the most part sub rosa, have been often felt in the history of nations, from the Biblical episode of Baal-peor down to modern times. The evidence is written at large in the works of Astruc, Hensler and Rosenbaum. We are here concerned with a much smaller matter, namely, any evidence from England which may throw light upon the classes of cases that were called leprous if they were called by a name at all.
Under the year 1258, Matthew Paris introduces a singular paragraph, which is headed, “The Bishop of Hereford smitten with polypus.” The bishop, a Provençal, had made himself obnoxious by his treacherous conduct as the agent of Henry III. at the Holy See in the matter of the English subsidies to the pope. Accordingly it was by the justice of God that he was deformed by a most disgraceful disease, to wit, morphea, or again, “morphea polipo, vel quadam specie leprae[149].” According to the medical teaching of the time, as we find it in Gilbertus Anglicus, morphaea was an infection producing a change in the natural colour of the skin; it was confined to the skin, whereas lepra was in the flesh also; the former was curable, the latter incurable; morphaea might be white, red, or black[150]. The account of morphaea by Gordonio is somewhat fuller. All things, he says, that are causes of lepra are causes of morphaea; so that what is in the flesh lepra is morphaea in the skin. It was a patchy discoloration of the skin, reddish, yellowish, whitish, dusky, or black, producing terribilis aspectus; curable if recent, incurable if of long standing; curable also if of moderate extent, but difficult to cure if of great extent[151]. In this description by Gordonio a modern French writer on leprosy[152] discovers the classical characters of the syphilis of our own day: “not one sign is wanting.”
No doubt the medical writers drew a distinction between morphaea and lepra, as we have seen in quoting Gilbert and Gordonio. Gaddesden, also, who mostly copies them, interpolates here an original remark. No one should be adjudged leprous, he says, and separated from his fellows, merely because the “figure and form” (the stock phrase) of the face are corrupted: the disease might be “scabies foeda,” or if in the feet, it might be “cancer.” Nodosities or tubercles should not be taken to mean leprosy, unless they are confirmed (inveterate) in the face[153]. But how uncertain are these diagnostic indications, as between lepra and morphaea, lepra and “scabies foeda,” lepra and “cancer in pedibus!” If there were any object in calling the disease by one name rather than another, it is clear that the same disease might be called by a euphemism in one case and by a term meant to be opprobrious in another. Although leprosy was not in general a disease that anyone might wish to be credited with, yet there were circumstances when the diagnosis of leprosy had its advantages. It was of use to a beggar or tramp to be called a leper: he would excite more pity, he might get admission to a hospital, and he might solicit alms, under royal privilege, although begging in ordinary was punishable. It is conceivable also that the diagnosis of leprosy was a convenient one for men in conspicuous positions in Church and State. It is most improbable that the “lepra Normannorum” was all leprosy; it is absurd to suppose that leprosy became common in Europe because returning Crusaders introduced it from the East, as if leprosy could be “introduced” in any such way; and it is not easy to arrive at certitude, that all the cases of leprosy in princes and other high-placed personages (Baldwin IV. of Jerusalem who died at the age of twenty-five,[154] Robert the Bruce of Scotland,[155] and Henry IV. of England[156]) were cases that would now be diagnosed leprous.
Instances may be quoted to show that the name of leper was flung about somewhat at random. Thus, in an edict issued by Henry II., during the absence of Becket abroad for the settlement of his quarrel with the king, it was decreed that anyone who brought into the country documents relating to the threatened papal interdict should have his feet cut off if he were a regular cleric, his eyes put out if a secular clerk, should be hanged if a layman, and be burned if a leprosus—that is to say, a beggar or common tramp. Again, in the charges brought for Henry III. against the powerful minister Hubert de Burg in 1239, one item is that he had prevented the marriage of our lord the king with a certain noble lady by representing to the latter and to her guardian that the king was “a squinter, and a fool, and a good-for-nothing, and that he had a kind of leprosy, and was a deceiver, and a perjurer, and more of a craven than any woman[157]” etc.
There is also a curious instance of the term leprous being applied to the Scots, evidently in the sense in which William of Malmesbury, and many more after him, twitted that nation with their cutaneous infirmities. When the Black Death of 1348-9 had reached the northern counties of England, the Scots took advantage of their prostrate state to gather in the forest of Selkirk for an invasion, exulting in the “foul death of England.” Knighton says that the plague reached them there, that five thousand of them died, and that their rout was completed by the English falling upon them[158]. But the other contemporary chronicler of the Black Death, Geoffrey le Baker[159], tells the story with a curious difference. The Scots, he says, swearing by the foul death of the English, passed from the extreme of exultation to that of grief; the sword of God’s wrath was lifted from the English and fell in its fury upon the Scots, “et [Scotos] per lepram, nec minus quam Anglicos per apostemata et pustulos, mactavit.” The apostemata and pustuli were indeed the buboes, boils and carbuncles of the plague, correctly named; but what was the lepra of the Scots? It was probably a vague term of abuse; but, if the clerk of Osney attached any meaning to it, it is clear that he saw nothing improbable in a disease called lepra springing up suddenly and spreading among a body of men.
We conclude, then, that lepra was a term used in a generic sense because of a real uncertainty of diagnosis, or because there was some advantage to be got from being called leprosus, or because it was flung about at random. But there is still another reason for the inexact use of the terms lepra and leprosus in the medieval period, namely, the dominant influence of religious tradition. The heritage or accretion of religious sentiment not only perverted the correct use of the name, but led to regulations and proscriptions which were out of place even for the real disease.
The Biblical Associations of Leprosy.
Among the synonyms for leprosi we find the terms “pauperes Christi, videlicet Lazares,” the name of “Christ’s poor” being given to lepers by Aelred in the twelfth century and by Matthew Paris in the thirteenth. The association of ideas with Lazarus is a good sample of the want of discrimination in all that pertains to medieval leprosy. The Lazarus of St Luke’s Gospel, who was laid at the rich man’s gate full of sores, is a representative person, existing only in parable. On the other hand, the Lazarus of St John’s Gospel, Lazarus of Bethany, the brother of Martha and Mary, the man of many friends, is both a historical personage and a saint in the calendar. But there is nothing to show that he was a leper. He had a remarkable experience of restoration to the light of day, and it was probably on account of an episode in his life that made so much talk that he received posthumously the name of Lazarus, or “helped of God[160].” The name of the man in the parable is also generic, just as generic as that of his contrast Dives is; but specifically there was nothing in common between the one Lazarus and the other. Yet St Lazarus specially named as the brother of Martha and Mary (as in the charter of the leper-house at Sherburn) became the patron of lepers. The ascription to Lazarus of Bethany of the malady of Lazarus in the parable has done much for the prestige of the latter’s disease; in the medieval world it brought all persons full of sores within a nimbus of sanctity, as being in a special sense “pauperes Christi,” the successors at once of him whom Jesus loved and of “Lazarus ulcerosus.” Doubtless the lepers deserved all the charity that they got; but we shall not easily understand the interest exceptionally taken in them, amidst abounding suffering and wretchedness in other forms, unless we keep in mind that they somehow came to be regarded as Christ’s poor.
Next to the image of Lazarus, or rather the composite image of the two Lazaruses, the picture of leprosy that filled the imagination was that of the thirteenth and fourteenth chapters of Leviticus. That picture is even more composite than the other, and for leprosy in the strict sense it is absolutely misleading. The word translated “leprosy” is a generic term for various communicable maladies, most of which were curable within a definite period, sometimes no longer than a week. It rested with the skill of the priesthood to discriminate between the forms of communicable disease, and to prescribe the appropriate ceremonial treatment for each; the people had one common name for them all, and beyond that they were in the hands of their priests, who knew quite well what they were about. The Christian Church dealt with all those archaic institutions of an Eastern people in a child-like spirit of verbal or literal interpretation, doubtless finding the greater part of them a meaningless jargon. But some verses would touch the imagination and call up a real and vivid picture, such verses, for example, as the following:
“And the leper in whom the plague is, his clothes shall be rent, and his head bare, and he shall put a covering upon his upper lip, and shall cry, Unclean, unclean. All the days wherein the plague shall be in him he shall be defiled; he is unclean; he shall dwell alone; without the camp shall his habitation be.”