Medieval lepers and leprosy

The order of St Lazarus was ‘founded on lepers’ and throughout its 400-year history in England it relentlessly projected the image of the suffering leper to solicit gifts of land and win privileges from the crown and papacy. Leprosy indisputably lay at the root of the order’s founding ideology, but the extent to which this sustained exploitation was justified is a question very much open to debate. Not only is leprosy a very unpleasant disease, it is also an extraordinarily complex one, and modern medical research has identified it in at least five different forms. The most serious is low-resistant lepromatous leprosy (Hansen’s disease), which was prevalent in Europe and the Holy Land in the early Middle Ages and is spread by droplet infection. However, it is not easy to contract this strain of leprosy. Hamilton notes, ‘Contrary to popular belief, it is difficult to transmit from person to person and usually close contact is required for months or years before the disease is passed from one person to another.’ In the Middle Ages it was therefore very much a malady associated with specific families and households, and it has been estimated that this sort of regular and prolonged exposure to the bacterium increases the risk of infection by up to 20 per cent.

After infection symptoms may not appear for between five and ten years, though the sufferer is capable of spreading the disease during this long incubation period. The bacterium prefers the cooler extremities of the body, and it is in these areas where its early effects are most apparent, attacking the nervous system, invading bone and impeding blood circulation. The damage done in this way leads to localised anaesthesia, and because of this the leper becomes prone to injury at points of pressure on the hands and feet. The absence of any sensation of pain often leads to ulceration of untreated injuries and, ultimately, serious damage to these vulnerable parts of the body. In its later stages lepromatous leprosy is grotesquely disfiguring, with distortion of the facial features and the degeneration of hands and feet. However, in terms of the archaeological evidence,Manchester estimates that no more than 50 per cent of victims exhibit these extreme characteristics.