As leprosy began increasing in prevalence in the 11th century, so did the development of leper hospitals or leprosarium. Archaeological evidence supports the historical documents denoting separation of the sick from the healthy. Excavations done by Farley and Manchester (1989) in High Wyncombe, found that there are four hospitals, St. John the Baptist, St. Giles, St. Gilbert and St. Margaret, two of which are confirmed leprosaria. Each of the hospitals had their own attached church and cemeteries. They were located away from the main habitation center, and St. Margaret’s was even quartered off by a man-made stream on three sides. A known non-leper hospital, St. Mary’s, however, was designed for the poor and sits safely within the city walls (Farley and Manchester 1989:88).
Other hospitals that have been extensively researched are those of St. James and St. Mary Magdalene’s in Chichester (Lee and Magilton 1989:273). These two hospitals are located almost a kilometer outside of the town, and were meant for those who had been expelled from the city for leprous diseases. In its documented rules, St. James was said to have been built in order to “pray for the king, the realm and all benefactors and to recite the Creed, a hundred Lord’s prayers and Salutations” (Lee and Magilton 1989:274). This confirms the medieval belief that leprosy was caused by sin and could only be cured through the separation and prayer that the Bible prescribed. At St. Mary Magdalene’s one had to endure fifteen days of penance, although this increased to forty in the 14th century as the infection became more epidemic (Rawcliffe 2006:133). The number of leprosaria and hospitals increased steadily through the 12th century, reaching its apex during the 13th century. In Britain alone there are 202 well-documented leper hospitals dating to the Late Medieval Period, and in Ireland there are 50 (Manchester and Roberts 1989:269, Murphy and Manchester 2002:193).
Archaeological surveys of hospitals reveal trends in the choices of patron saints. In Britain, prevalent leprosy associated saint names include St. Mary Magdalene, St. Giles, St. James, St. Leonard, St. Lazare, St. Laurence, and St. Nicholas (Rawcliffe 2006:418-421, Farley and Manchester 1989:88). Of these, St. Mary Magdalene appears to be the most popular choice. This is due to her status as an outcast, who realizes her sin and is cleansed by Christ in Luke 8.2 (Coogan 2001:111NT). It was believed that not only was she forgiven for her physical uncleanliness, but also her spiritual pollution. In Ireland, the main patron saints are St. Mary Magdalene, St. John the Baptist, St. Stephen and St. Giles. In the 13th century, Ireland has evidence for two leper hospitals named St. Stephen’s; one near Dublin and one by Waterford (Murphy and Manchester 2002:195). By knowing the patron saints, churches and hospitals can be identified as possible leprosaria.
The architecture of the hospitals and churches can also reveal their use. Kealey (1981:105) argues that there are marked architectural differences between hospitals where residents were there by choice, and ones where they were chronically ill and quarantined. St. Cross Hospital, not associated with leprosy, has features like courtyards, common halls, large attached chapel, and small apartments for the ill. In comparison, the leper hospital in Reading has only one small common room, and a separate wing for the sick. Some leper hospitals, like the one in Harbledown, had separate wooden houses for the infected (Steane 1984:97). Churches may also have architectural features denoting the presence of leprosy. A leper’s window or “squint” have been found built into church walls. These were small openings in the stone which would have allowed lepers to hear the sermons taking place within the church without disturbing the people inside (Richards 2000:86). The 15th century church of St. Nicholas in Carrickfergus, Ireland, contains a small leper window, and during the medieval times also had a leprosarium located at the outskirts of the city (Murphy and Manchester 2002:194).
In order to understand the community as a whole, it is also important to look at the skeletal evidence of those who are not considered leprous. Evidence from a series of four excavations of Medieval cemeteries in Denmark showed that segregation within cemeteries was common, but only for those suffering from facies leprosa or the more extreme cases of Lepromatous leprosy (Boldsen and Mollerup 2006). Lepers were supposed to be segregated from the main population, but skeletal evidence found by Boldsen and Mollerup prove otherwise. The leper cemetery of St. Jørgensgârd in Odense has been thoroughly excavated, but the other non-leper cemeteries had not been until recently. Samples were taken from four non-leper cemeteries, St. Albani, Gray Friars, St. Knud and Black Friars. Boldsen and Mollerup’s sample of 733 skeletons from the four cemeteries showed that “Leprosy was present in medieval Odense, and some personas suffering from the disease were buried in ordinary cemeteries, while people with predominantly facial signs of the disease were selectively removed from the population” (2006:349). This study shows that the stigma against lepers was based more on their perceived sickness due to outward superficial appearance.
It is important to note that the biological indicators of the disease do not necessarily correlate with how the population perceived those infected. One cannot assume that if leprosy is found in a cemetery, then the whole cemetery was meant for this purpose; social behavior has a large affect on what is perceived as being ‘leprous’ (Boldsen 2001:385). In the studies done by Møller-Christensen in Denmark, he found that of the 500 skeletons at Naestved, only 70% had true leprosy. It is possible that the remaining 30% ended up in the leper cemetery due to other skin and flesh related illnesses (Manchester 1964:171). From the biological evidence, it seems likely that other visible skin ailments like eczema, pellagra, or psoriasis could have been diagnosed as leprosy (Covey 2001:316). By studying more than just the leper cemetery at St. Jørgensgârd, Boldsen and Mollerup are able to create a broader understanding of the beliefs of the time period and the social reactions of the living medieval population.
Austin (1990:9) argues that the main problem with medieval archaeology is that it is framed by the archaeologist’s assumed knowledge of historical data. Excavations like Brander and Lynnerup’s (2002) began by looking at historical records that indicated the location of a leper cemetery. In other studies, the use of local or historical knowledge may be left implicit. Another limitation of archaeological studies is that one cannot assume that the initial purpose of a building or object correlates with its use. Steane (1984:97) discusses how glass flasks were used for urinalysis in diagnosing leprosy, but these same bottles could have been used for other medical or alchemy related purposes. One of the problems with identifying leper hospitals is that they often had multiple uses. Many began as monastic infirmaries, and in the 12th century were converted as the disease grew more prevalent. Once leprosy began dying out in the 1500’s, the buildings were often used as normal hospitals or almshouses for the poor (Schofield and Vince 1994:174). Other architectural features like squints have been questioned as to the validity of their being designed for leper use due to a lack of contemporary evidence (Murphy and Manchester 2002:194). When the frame of historical data is removed, archaeological evidence becomes obfuscated.
Stay tuned tomorrow for the stunning conclusion to our romp through leprosy!