Laws for the “living dead”: Dealing with those suffering from leprosy from the perspective of medieval law
by Kay Peter Jankrift
Insights into a “different” disease
“Leprosy is different”, wrote Richard Toellner in the introductory article of the publication commemorating the 650th anniversary of the Rectorate Münster-Kinderhaus (Toellner 1992: 1-7). With these three words, the then Director of the Institute for Theory and History of Medicine at the University of Münster characterized an infectious disease that condemned its victims in medieval and early-modern Latin Europe just as inevitably to death after what was often a long period of infirmity, as to “social death” while still alive (Toellner 1992: 1). Unlike the Black Death in the mid-14th century and subsequent epidemics, leprosy at no time left behind mountains of corpses. It did not affect the collective; it affected individuals. Estimates of leprosy mortality vary widely. In general, however, research in (medical) history assumes that the mortality rate was probably very low, even during the presumed peak of the infectious disease in the 13th and 14th centuries (Wolf 1989: 102, notes 5 and 6).
It should be pointed out here that the exclusion of those with leprosy is by no means a thing of the distant past. According to recent information from the “German Leprosy and Tuberculosis Relief Association”, those affected still often face stigmatization and social exclusion in some regions of the world where leprosy is still present today (DAHW 2022; Fessler 2020; Barrett 2005: 216-230).
One of the striking peculiarities of how those with leprosy and leprosy itself were treated in pre-modern Europe is that no other disease – not even the epidemics perceived by contemporaries as plague – attracted over the centuries such a large number and range of regulations in secular and canon law. Reaching a better understanding of the background to this extensive legislation in relation to those with leprosy requires some remarks on the symptoms of the disease, the appearance of those affected, and the contemporary ideas associated with it.
The clinical picture of leprosy
It was the Norwegian physician Gerhard Armauer Hansen (1841-1912) who in 1873 discovered the cause of the infectious disease defined today in medicine as “leprosy”: mycobacterium leprae (e.g. Irgens 2002: 708-709). Medical research assumes that mycobacterium leprae is primarily transmitted in repeated, close contact with sick people through droplet infection via the nasopharynx (e.g. Suzuki/Akama/Kawashima et al. 2012). Poor hygiene, inadequate nutrition, and a weakened immune system increase the chances of infection (Montoya/Modlin 2010). The virus is relatively uncontagious, so that a functioning immune system can usually fight it without symptoms occurring (Suzuki/Akama/Kawashima et al. 2012). The incubation period is several months, sometimes even years (e.g. Suzuki/Akama/Kawashima et al. 2012), and a period of up to 40 years between infection and the outbreak of the disease has been observed in individual cases (Jankrift 1996: 9).
Leprosy takes different forms. It primarily attacks the skin tissue and the Schwann cells of the peripheral nervous system (Suzuki/Akama/Kawashima et al. 2012), leading among other things to the appearance of the symptoms so characteristic of the disease, such as the formation of nodular infiltrates, especially on the face, and brown-red, insensate patches on the skin (Jankrift 1996: 9). Injuries to such patches often go unnoticed by the sufferer, so that further tissue is destroyed by inflammation until mutilations of the hands and feet develop. As the disease progresses, a fusion of these infiltrates leads to the so-called “lion face” (facies leonina). The nose collapses, the eyebrows disappear, ulcers form on the mucous membranes of the nasopharynx, the voice becomes rough due to changes in the larynx, and the sufferer goes blind. Once the virus enters the bloodstream, the internal organs are also affected. Leprosy is chronic, with death following after years or decades of suffering.
Although leprosy can be successfully treated with drugs today, research into vaccines is still extremely difficult (Gensthaler 2020; Just 1992: 128-133), a major reason being that it has not yet been possible to cultivate mycobacterium leprae on culture media in the laboratory (Gensthaler 2020). Against all odds, the clinical phase for testing a vaccine against leprosy called LepVax has recently begun after 17 years of development (Natter 2021).
Ideas of “leprosy” in medieval and early-modern medicine
Given the severe symptoms associated with an untreated disease, we can guess how much fear of leprosy there was in the Middle Ages and early modern period, the fear of infection unquestionably being increased by the lack of effective cures as well as by the social repercussions for the sufferer. Ideas of leprosy and its causes then differ significantly from the current medical definition of the disease. It is impossible to make retrospective diagnoses solely through interpreting written testimonies, not least because medieval and early-modern medical science with the Hippocratic-Galenic corpus and its four-humour doctrine was based on different models of medical theory than medicine today (e.g. Stolberg 2012; Leven 1998). Thus, the clinical manifestations of the phenomena perceived as leprosy in the Middle Ages and early modern period concealed a broad spectrum of different diseases (Jankrift 2005: 132-136).
According to medical ideas then, leprosy was fostered by an excess of so-called “black bile”, one of the four humours, which itself was caused by the excessive consumption of certain foods, as well as by a poor lifestyle (Jankrift 2014: 29-35). However, contemporary opinion also viewed leprosy primarily as a divine punishment for sin (Pichon 1988: 147-157). With illness being marked by the stigma of sinfulness in the eyes of the healthy, leprosy also caused “impurity” in the religious sense, with those suffering from leprosy being excluded from the religious community. Such beliefs were based on the book of Leviticus (Lev 13:46), which states among other things that lepers should loudly proclaim their state of impurity and remain outside the camp for the duration of their illness. Later interpretations of these passages in the Latin-Christian world of the Middle Ages deviated from the original understanding of “leprosy” in the Torah (Jankrift 2019), and derived from this a permanent ritual “impurity” of the sick, as well as the need to separate them from the healthy. This basic idea permeated both canon and secular law with regard to lepers for centuries (Uhrmacher 2011: 24-30; Merzbacher 1967; Reicke 1932: 234-258; Imbert 1947: 151-195). I will now use some examples to show the forms in which such thinking manifested itself in legal norms and had an impact in practice.
Lepers from the perspective of the law
The oldest canonical legal documents on the treatment of lepers date back to the 6th century. Decisions made by the Council of Orléans in 549 ordered the bishops to use church assets to provide food and clothing for those in their diocese and town afflicted with the disease (De Clerq 1973: 156). Around the same time, the first hospital facilities for lepers were established in the Merovingian Empire, for example in Châlons-sur-Saône in Champagne around 550 (Uhrmacher: 20-21). In 583, the Council of Lyon confirmed the decisions made in Orléans, but also stipulated that the sick should not be allowed to wander to other towns (De Clerq 1973: 232-233), which suggests that some of the designated recipients of alms had previously tried to secure alms in different places.
The first known regulations of secular law on the status of lepers appeared in 643 in the Edictus Rothari, the code of the Longobard king Rothari († 652), which states that lepers whose condition became known to the judges were to be expelled from the town and their house, with their power of disposal over their property also being withdrawn (Blume 1868: 41). Once expelled, the lepers were considered by the law “as if dead” (tamquam mortuus), with legal death being clearly distinguished from physical death, since the legal text goes on to say that the sick person should be provided for during his or her lifetime (dum advixerit) from the property that he or she left behind (Blume 1868: 41).
In some regions of France, this “legal death” was most drastically enacted in the later Middle Ages by special ecclesiastical rites (Martène ²1736: 1003-1013), lepers having among other things to participate in their own funeral mass and to climb symbolically into a dug grave, with the priest proclaiming that the sick person was dead to the world, but would live on in God (Sis mortuus mundo vivens iterum in Deo).
Probably the most important milestone in canon law with regard to the treatment of lepers in the medieval and early-modern world was the decision of the Third Lateran Council in 1179 (Alberigo/Leonardi 1973: 222-223; Avril 1981), which stipulated among other things that lepers should live together in their own houses, separate from healthy people, and have their own places of worship and cemeteries. The number of so-called leprosariums, which as a rule had a chapel and a burial ground, grew rapidly in the period that followed, together with the flourishing of the European urban system (e.g. Uhrmacher 2011).
However, the condition of the “living dead” inevitably gave rise to a multitude of other problems, some of which touched upon both secular and canon law. For example, the question arose as to whether marriages between healthy people and those with leprosy could continue, or whether divorce was allowed, or even whether a leprous man could be king. The establishment of leprosariums outside city walls also led to further legal regulations of local or territorial validity. Finally, given the serious repercussions of leprosy, the important and fundamental question inevitably arose of the modalities of a legally binding diagnosis. However, a nuanced examination of these problems must be left to a more comprehensive study, and my remarks have fulfilled their purpose if they have succeeded in briefly illuminating the complexity of this subject area.
Alberigo, Joseph/Leonardo, Claudio e.a. (Eds.), Concilium Oecumenicorum Decreta, Bologna 1973.
Avril, Jean, Le IIIe concile de Lateran et les communautes des lépreux, in: Revue Mabillon 60 (1981), S. 21-76.
Barrett, Self-Mortification and the Stigma of Leprosy in Northern India, in: Medical Anthropology Quarterly 19 (2005), S. 216-230.
Blume, Friederich, Edictus Langobardorum, in: Georg Heinrich Pertz (Hrsg.), Monumenta Germaniae Historica. Legum Tomus IIII, Hannover 1868, S. 1-225.
DAHW, https://www.dahw.de/unsere-arbeit/medizinische-soziale-arbeit/lepra.html [Abruf 05.01.2022]
De Clerq, Charles (Ed.), Concilia Galliae A. 511- A. 695 (Corpus Christianorum. Series Latina CXLVIII A), Tournhout 1973.
Fessler, Pam, Carville’s Cure: Leprosy, Stigma and the Fight for Justice, New York 2020.
Gensthaler, Brigitte M., Lepra. Alte Erkrankung mit vielen Unbekannten, in: Pharmazeutische Zeitung. Die Zeitschrift der Deutschen Apotheker, vom 24.01.2020 unter: https://www.pharmazeutische-zeitung.de/alte-erkrankung-mit-vielen-unbekannten/ [Abruf: 20.01.2022].
Imbert, Jean, Les hôpitaux en droit canonique, Paris 1947.
Irgens, Lorentz M., Oppdagelsen av leprabasillen, in: Tidsskriftet den Norske Legeforening 122 (2002), S. 708-709.
Jankrift, Kay Peter, Lepra Hebraeorum. Ein antisemitisches Krankheitskonstrukt des 19. Jahrhunderts und seine Entwicklung, in: Robert Jütte/Andreas Kilcher (Hrsg.), Judentum und Krankheit (Aschkenas. Zeitschrift für Geschichte und Kultur der Juden 29), Berlin 2019, S. 27-42.
Jankrift, Kay Peter, Löwenfleisch, faule Birnen und Antoniuswein. Pest, Lepra, Heiliges Feuer und die Rolle der Ernährung aus Sicht der mittelalterlich-frühneuzeitlichen Heilkunde, in: Andrea Hofmeister-Winter/Helmut W. Klug/Karin Kranich (Hrsg.), Der Koch ist der bessere Arzt. Zum Verhältnis von Diätetik und Kulinarik im Mittelalter und in der Frühen Neuzeit (Mediävistik zwiscehn Forschung, Lehre und Öffentlichkeit 8), Frankfurt am Main 2014, S. 19-35.
Jankrift, Kay Peter, Mit Gott und Schwarzer Magie. Medizin im Mittelalter, Darmstadt 2005.
Jankrift, Kay Peter, Leprose als Streiter Gottes. Institutionalisierung und Organisation des Ordens vom Heiligen Lazarus zu Jerusalem von seinen Anfängen bis zum Jahre 1350 (Vita Regularis. Ordnungen und Deutungen religiosen Lebens im Mittelalter 4), Münster 1996.
Just, Ivo, Moderne Arzneimitteltherapie der Lepra, in: Richard Toellner (Hrsg.), Lepra-Gestern und Heute. 15 wissenschaftliche Essays zur Geschichte und Gegenwart einer Menschheitsseuche. Gedenkschrift zum 650-jährigen Bestehen des Rektorats Münster-Kinderhaus, Münster 1992, S. 128-133.
Leven, Karl-Heinz, Krankheiten: Historische Deutung versus retrospektive Diagnose, in: Norbert Paul/Thomas Schlich (Hrsg.), Medizingeschichte: Aufgaben, Probleme, Perspektiven, Frankfurt am Main 1998, S. 153-185.
Martène, Edmond (Hrsg.), De antiquis ecclesiae ritibus, Bd. II, Antwerpen ²1736 [Neudruck: Hildesheim 1967]
Merzbacher, Friedrich, Die Leprosen im alten kanonischen Recht, in: Zeitschrift der Savigny-Stiftung für Rechtsgeschichte 84, Kanonische Abteilung 53 (1967), S. 27-45.
Montoya, Dennis/Modlin, Robert L., Learning from Leprosy: Insight into the Human Innate Response, in: Frederick W. Alt (Ed.), Advances in Immunology 105 (2010), S. 1-24.
Natter, Alice, Impfstoff gegen Lepra: DAHW setzt auf klinische Test in diesem Jahr, in: Mainpost vom 31.01.2021, unter: https://www.mainpost.de/regional/wuerzburg/impfstoff-gegen-lepra-dahw-setzt-auf-klinische-test-in-diesem-jahr-art-10559703 [Abruf: 20.02.2022].
Pichon, Geneviève, La lèpre et le péché. Étude dùne représentation médiévale, in: Nouvelle Revue de Psychoanalyse 38 (1988), S. 147-157.
Reicke, Siegfried, Das deutsche Spital und sein Recht im Mittelalter. Zweiter Teil: Das deutsche Spitalrecht (Kirchenrechtliche Abhandlungen 113 u. 114), Stuttgart 1932 [Neudruck: 1961].
Toellner, Richard, Zur Einführung: Lepra ist anders, in: Richard Toellner (Hrsg.), Lepra-Gestern und Heute. 15 wissenschaftliche Essays zur Geschichte und Gegenwart einer Menschheitsseuche. Gedenkschrift zum 650-jährigen Bestehen des Rektorats Münster-Kinderhaus, Münster 1992, S. 1-7.
Stolberg, Michael, Möglichkeiten und Grenzen einer retrospektiven Diagnostik, in: Waltraud Pulz (Hrsg.), Zwischen Himmel und Erde. Körperliche Zeichen der Heiligkeit, Stuttgart 2012, S. 209-227.
Suzuki, Koichi/Akama, Takeshi/Kawashima, Akira e.a., Current Status of Leprosy: Epidemiology, basic science and clinical perspectives, in: The Journal of Dermatology 39 (2012), S. 121-129.
Uhrmacher, Martin, Lepra und Leprosorien im rheinischen Raum vom 12. bis zum 18. Jahrhundert (Beiträge zur Landes- und Kulturgeschichte. Publications du CLUDEM 36), Trier 2011.
Wolf, Jörn Henning, Zur historischen Epidemiologie der Lepra, in: Neithard Bulst/Robert Delort (Eds.), Maladies et société (XIIe-XVIIIe siècles). Actes du colloque de Bielefeld, novembre 1986, Paris 1989, S. 99-120.