1307. Future research may perhaps discover where Gilbert taught or was

taught; meanwhile we may safely assume that his scholarship and system were of a foreign colour. The medical writer of that time in England was John of Gaddesden, mentioned in the end of the foregoing chapter; he is the merest plagiary, and the one or two original remarks in his chapter ‘De Lepra’ would almost justify the epithet of “fatuous” which Guy de Chauliac applied to him. Although we cannot appeal to Gilbertus Anglicus for native English experience any more than we can to his _alter ego_, Gordonio, yet we may assume that the picture of leprosy which they give might have been sketched in England as well as in Italy or in Provence. The conditions were practically uniform throughout Christendom; the true leprosy of any one part of medieval Europe is the true leprosy of the whole. Gilbert’s picture[136], as we have said, is unmistakeable, and the same might be said of Bernard’s[137]--the eyebrows falling bare and getting knotted with uneven tuberosities, the nose and other features becoming thick, coarse and lumpy, the face losing its mobility or play of expression, the raucous voice, the loss of sensibility in the hands, and the ultimate break-up or _naufragium_ of the leprous growths into foul running sores. The enumeration of nervous symptoms, which are now recognised to be fundamental in the pathology of leprosy, shows that Gilbert went below the surface. Among the “signa leprae generalia” he mentions such forms of hyperaesthesia as _formicatio_ (the creeping of ants), and the feeling of “needles and pins;” and, in the way of anaesthesia, he speaks of the loss of sensibility from the little finger to the elbow, as well as in the exposed parts where the blanched spots or thickenings come--the forehead, cheeks, eyebrows, to which he adds the tongue. Gilbert’s whole chapter ‘De Lepra’ is an obvious improvement upon the corresponding one in Avicenna, who says that _lepra_ is a cancer of the whole body, cancer being the _lepra_ of a single member, and is probably confusing lupus with leprosy when he describes the cartilages of the nose as corroded in the latter, and the nostrils destroyed by the same kind of _naufragium_ as the fingers and toes. All students of the history or clinical characters of leprosy, from Guy de Chauliac, who wrote about 1350, down to Hensler and Sprengel, have recognised in Gilbert’s and Bernard’s account of it the marks of first-hand observation; so that we may take it, without farther debate, that leprosy, as correctly diagnosed, was a disease of Europe and of Britain in the Middle Ages. Having got so far, we come next to a region of almost inextricable confusion, a region of secrecy and mystification, as well as of real contemporary ignorance. We may best approach it by one or two passages from Gilbert and Gordonio themselves. The systematic handling of _lepra_ in their writings is one thing, and their more concrete remarks on its conditions of origin, its occasions, or circumstances are another. What are we to make of this kind of leprosy?--“In hoc genere, causa est accessus ad mulierem ad quam accessit prius leprosus; et corrumpit velocius vir sanus quam mulier a leproso.... Et penetrant [venena] in nervos calidos et arterias et venas viriles, et inficiunt spiritus et bubones, et hoc velocius si mulier,” etc. Or to quote Gilbert again: “Ex accessu ad mulieres, diximus superius, lepram in plerisque generari post coitûs leprosos[138].” Or in Gordonio: “Et provenit [lepra] etiam ex nimia confibulatione cum leprosis, et ex coitu cum leprosa, et qui jacuit cum muliere cum qua jacuit leprosus[139].” That these circumstances of contracting _lepra_ were not mere verbal theorizings inspired by the pathology of the day and capable of being now set aside, is obvious from a _historia_ or case which Gordonio introduces into his text. “I shall tell what happened,” he says; and then proceeds to the following relation:[140] “Quaedam comtissa venit leprosa ad Montem Pessulanum [Montpellier], et erat in fine in cura mea; et quidam Baccalarius in medicina ministrabat ei, et jacuit cum ea, et impregnavit eam, et perfectissime leprosus factus est.” Happy is he therefore, he adds, who learns caution from the risks of others. Here we have sufficient evidence, from the beginning of the fourteenth century, of a disease being called _lepra_ which does not conform to the conditions of leprosy as we now understand them. The same confusion between leprosy and the _lues venerea_ prevailed through the whole medieval period. Thus, in the single known instance of a severe edict against lepers in England, the order of Edward III. to the mayor and sheriffs of London in 1346[141], the reasons for driving lepers out of the City are given,--among others, because they communicate their disease “by carnal intercourse with women in stews and other secret places,” and by their polluted breath. It was pointed out long ago by Beckett in his paper on the antiquity of the _lues venerea_[142], that the polluted breath was characteristic of the latter, but not of leprosy. Of course the pollution of their breath might have meant no more than the theoretical reasoning of the books (as in Gilbert, where the breath of lepers, as well as the mere sight of them, is said to give the disease, p. 337), but the breath was probably obnoxious in a more real way, just as we know, from Gordonio’s case at Montpellier, that the other alleged source of “leprous” contagion was no mere theoretical deduction. As the medieval period came to an end the leper-houses (in France) were found to contain a miscellaneous gathering of cases generically called leprous; and about the same time, the year 1488, an edict of the same purport as Edward III.’s London one of 1346, was issued by the provost of Paris against _les lépreux_ of that city. The year 1488 is so near the epidemic outburst of the _morbus Gallicus_ during the French campaigns on Italian soil in 1494-95, that the historian has not hesitated to set down that sudden reappearance of leprous contagion, in a proclamation of the State, to a real prevalence already in Paris of the contagious malady which was to be heard of to the farthest corners of Europe a few years after[143]. There is no difficulty in producing evidence from medieval English records of the prevalence of _lues venerea_, which was not concealed under the euphemistic or mistaken diagnosis of leprosy. Instances of a very bad kind, authenticated with the names of the individuals, are given in Gascoigne’s _Liber Veritatum_, under the date of 1433[144]. In the medieval text-books of Avicenna, Gilbert and others, there are invariably paragraphs on _pustulae et apostemata virgae_. In the only original English medical work of those times, by John Ardern, who was practising at Newark from 1349 to 1370, and came afterwards to London, appearances are described which can mean nothing else than condylomata[145]. From a manuscript prescription-book of the medieval period, in the British Museum, I have collected some receipts (or their headings) which relate, as an index of later date prefixed to the MS. says, to “the pox of old[146].” 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.” Even in that comparatively plain direction, the obvious suggestion that the unclean person would not always be unclean, and that there was a term to his stay outside the camp, would go for little in reading the scripture. The medieval religious world took those parts of the Jewish teaching that appealed to their apprehension, and applied them to the circumstances of their own time with as much of zeal as the common sense of the community would permit. We have clear evidence of the effect of the Levitical teaching about “leprosy” upon English practice in the ordinances of the St Albans leper hospital of St Julian, which will be given in the sequel. The Medieval Religious Sentiment towards Lepers. Several incidents told of lepers by the chroniclers bring out that exaggerated religious view of the disease. Roger of Howden has preserved the following mythical story of Edward the Confessor. Proceeding one day from his palace to the Abbey Church in pomp and state, he passed with his train of nobles and ecclesiastics through a street in which sat a leper full of sores. The courtiers were about to drive the wretched man out from the royal presence, when the king ordered them to let him sit where he was. The leper, waxing bold after this concession, addressed the king, “I adjure thee by the living God to take me on thy shoulders and bring me into the church;” whereupon the king bowed his head and took the leper upon his shoulders. And as the king went, he prayed that God would give health to the leper; and his prayer was heard, and the leper was made whole from that very hour, praising and glorifying God[161]. It is not the miraculous ending of this incident that need surprise us most; for the Royal touch by which the Confessor wrought his numerous cures of the blind and the halt and the scrofulous, continued to be exercised, with unabated virtue, down to the eighteenth century, and came at length to be supervised by Court surgeons who were fellows of the Royal Society. It is the humility of a crowned head in the presence of a leper that marks an old-world kind of religious sentiment. The nearest approach to it in our time is the feet-washing of the poor by the empress at Vienna on Corpus Christi day. A similar story, with a truer touch of nature in it, is told of Matilda, queen of Henry I.; and it happens to be related on so good authority that we may believe every word of it. Matilda was a Saxon princess, daughter of Margaret the Atheling, the queen of Malcolm Canmore. The other actor in the story was her brother David, afterwards king of Scots and, like his mother, honoured as a saint of the Church. The narrator is Aelred, abbot of Rievaulx, in the North Riding of Yorkshire, celebrated for his Latin style and his care for Saxon history. The abbot was a friend of St David, whose virtues he celebrates at length; the incident of queen Matilda and the lepers was one that he often heard from David’s own lips (quod ex ore saepe Davidis regis audivi). The princess Matilda, taking more after her mother than her father, had been brought up in an English convent under her aunt, the abbess of it. When it came to a marriage between her and Henry I., an alliance which was meant to reconcile the Saxons to Norman rule, the question arose in the mind of Anselm whether the princess Matilda had not actually taken the veil, and whether he could legally marry her to the king. Questioned as to the fact, the princess made answer that she had indeed worn the veil in public, but only as a protection from the licentious insolence of the Norman nobles. She had no liking for the great match arranged for her, and consented unwillingly although the king was enamoured of her. Such was her humility that Aelred designates her “the Esther of our times.” The marriage was on the 15th of November, 1100; and in the next year, according to the usual date given, the young queen sought relief and effusion for her religious instincts by founding the leper hospital of St Giles in the Fields, “with a chapel and a sufficient edifice.” Matthew Paris, a century and a half after, saw it standing as queen Matilda had built it, and made a sketch of it in colours on the margin of his page, still remaining to us in a library at Cambridge, with the description, “Memoriale Matild. Regine.” The story which her brother David told to the abbot of Rievaulx is as follows: When he was serving as a youth at the English Court, one evening he was with his companions in his lodging, when the queen called him into her chamber. He found the place full of lepers, and the queen standing in the midst, with her robe laid aside and a towel girt round her. Having filled a basin with water, she proceeded to wash the feet of the lepers and to wipe them with the towel, and then taking them in both her hands, she kissed them with devotion. To whom her brother: “What dost thou, my lady? Certes if the king were to know this, never would he deign to kiss with his lips that mouth of thine polluted with the soil of leprous feet.” But she answered with a smile: “Who does not know that the feet of an Eternal King are to be preferred to the lips of a mortal king? See, then, dearest brother, wherefore I have called thee, that thou mayest learn by my example to do so also. Take the basin, and do what thou hast seen me do.” “At this,” said David, narrating to the abbot, “I was sore afraid, and answered that I could on no account endure it. For as yet I did not know the Lord, nor had His Spirit been revealed to me. And as she proceeded with her task, I laughed--_mea culpa_--and returned to my comrades[162].” The example of his sister, however, was not lost upon him; for when he acquired the earldom and manor of Huntingdon, and so became an opulent English noble, he founded a leper-hospital there. Aelred sees him in Abraham’s bosom with Lazarus. The meaning of all this devotion to lepers is shown in the name which Aelred applies to them--_pauperes Christi_. In washing their feet the pious Matilda was in effect washing the feet of an Eternal King; and that, in her estimation, was better than kissing the lips of a mortal king. Again, in the Life of St Hugh of Lincoln we see the good bishop moved to treat the leprous poor with a sort of attention which they can hardly have needed or expected, merely because they were, as his biographer says, the successors of _Lazarus ulcerosus_, and the special _protegés_ of Jesus. Not a few, says the biographer, were kept in seclusion owing to that disease, both men and women. Bishop Hugh would take up his abode among them and speak to them words of good cheer, promising them the flowers of Paradise and an immortal crown. Having sent the women lepers out of the way, he would go round among the men to kiss them, and when he came to one who was more atrociously marked by the disease than another, he would hold him in a longer and more gracious embrace. It was too much for the bishop’s biographer: “Spare, good Jesus, the unhappy soul of him who relates these things”--horrified, as he says he was, at seeing the “swollen and livid faces, deformed and sanious, with the eyelids everted, the eyeballs dug out, and the lips wasted away, faces which it were impossible to touch close or even to behold afar off[163]”. But these horrible disfigurements of the face are by no means the distinctive marks of leprosy. The dragging down of the eyelids is an effect of leprosy but as likely to happen in lupus or rodent ulcer. The loss of the eyeball may be a leprous sign, or perhaps from tumour. The wasting of the lips is a characteristic feature of lupus, after it has scarred, or if there be an actual loss of substance, of epithelial cancer; in leprosy, on the other hand, the lips, as well as other prominent folds of the face, undergo thickening, and will probably remain thickened to the end. The sufferers who excited the compassion of St Hugh must have merited it; only they were not all lepers, nor probably the majority of them[164]. Two leper-stories are told to the honour of St Francis of Assisi. Seeing one day a friar of his order named James the Simple, consorting on the way to church with a leper from the hospital under his care, St Francis rebuked the friar for allowing the leper to be at large. While he thus admonished the friar, he thought that he observed the leper to blush, and was stricken with a sudden remorse that he should have said anything to hurt the wretched man’s feelings. Having confessed and taken counsel, he resolved, by way of penance, to sit beside the leper at table and to eat with him out of the same dish, a penance all the greater, says the biographer, that the leper was covered all over with offensive sores and that the blood and sanies trickled down his fingers as he dipped them in the dish. The other story is a more pleasing one. There was a certain leper among those cared for by the friars, who would appear from the description of him to have been one of the class of truculent impostors, made all the worse by the morbid consideration with which his disease, or supposed disease, was regarded. One of his complaints was that no one would wash him; whereupon St Francis, having ordered a friar to bring a basin of perfumed water, proceeded to wash the leper with his own hands[165]. These four tales, all of them told of saints except that of Matilda--she somehow missed being canonised along with her mother St Margaret and her brother St David--will serve to show what a halo of morbid exaggeration surrounded the idea of leprosy in the medieval religious mind. We live in a time of saner and better-proportioned sentiment; but the critical spirit, which has set so much else in a sober light, has spared the medieval tradition of leprosy. Not only so, but our more graphic writers have put that disease into the medieval foreground as if it had been the commonest affliction of the time. We are taught to see the figures of lepers in their grey or russet gowns flitting everywhere through the scene; the air of those remote times is as if filled with the dull creaking of St Lazarus’s rattle. Our business here is to apply to the question of leprosy in medieval Britain the same kind of scrutiny which has been applied to the question of famines and famine-fevers, and remains to be applied next in order to the great question of plague--the kind of scrutiny which no historian would be excused from if his business were with politics, or campaigns, or economics, or manners and customs. The best available evidence for our purpose is the history of the leper-houses, to which we shall now proceed. The English Leper-houses. The English charitable foundations, or hospitals of all kinds previous to the dissolution of the monasteries, including almshouses, infirmaries, Maisons Dieu and lazar-houses, amount to five hundred and nine in the index of Bishop Tanner’s _Notitia Monastica_. In the 1830 edition of the _Monasticon Anglicanum_, the latest recension of those immense volumes of antiquarian research, there are one hundred and four such foundations given, for which the original charters, or confirming charters, or reports of inquisitions, are known; and, besides these, there are about three hundred and sixty given in the section on “Additional Hospitals,” the existence and circumstances of which rest upon such evidence as casual mention in old documents, or entries in monastery annals, or surviving names and traditions of the locality. Our task is to discover, if we can, what share of this charitable provision in medieval England, embracing at least four hundred and sixty houses, was intended for the class of _leprosi_; what indications there are of the sort of patients reckoned _leprosi_; how many sick inmates the leper-houses had, absolutely as well as in proportion to their clerical staff; and how far those refuges were in request among the people, either from a natural desire to find a refuge or from the social pressure upon them to keep themselves out of the way. It is clear that the endowed hospitals of medieval England were in no exclusive sense leper-hospitals, but a general provision, under religious discipline, for the infirm and sick poor, for infirm and ailing monks and clergy, and here or there for decayed gentlefolk. The earliest of them that is known, St Peter’s and St Leonard’s hospital at York, founded in 936 by king Athelstane, and enlarged more especially on its religious side by king Stephen, was a great establishment for the relief of the poor, with no reference to leprosy; it provided for no fewer than two hundred and six bedesmen, and was served by a master, thirteen brethren, four seculars, eight sisters, thirty choristers and six servitors. When Lanfranc, the first Norman archbishop of Canterbury, set about organising the charitable relief of his see in 1084, he endowed two hospitals, one for the sick and infirm poor in general, and the other for _leprosi_[166]. The former, St John Baptist’s hospital, was at the north gate, a commodious house of stone, for poor, infirm, lame or blind men and women. The latter was the hospital of Herbaldown, an erection of timber, in the woods of Blean about a mile from the west gate, for persons _regia valetudine fluentibus_ (?), who are styled _leprosi_ in a confirming charter of Henry II.[167] The charge of both these houses was given to the new priory of St Gregory, over against St John Baptist’s hospital, endowed with tithes for secular clergy. The leper-house at Herbaldown was divided between men and women; but in a later reign (Henry II.) a hospital entirely for women (twenty-five leprous sisters) was founded at Tannington, outside Canterbury, with a master, prioress and three priests. There was still a third hospital at Canterbury, St Lawrence’s, founded about 1137, for the relief of leprous monks or for the poor parents and relations of the monks of St Augustine’s. London had two endowed leper-hospitals under ecclesiastical government, as well as certain spitals or refuges of comparatively late date. The hospital and chapel of St Giles in the Fields was founded, as we have seen, by Matilda, queen of Henry I., in 1101, and was commonly known for long after as Matilda’s hospital. It was built for forty _leprosi_, who may or may not all have lived in it; and it was supported in part by the voluntary contributions of the citizens collected by a proctor. Its staff was at first exceptionally small for the number of patients,--a chaplain, a clerk and a messenger; but as its endowments increased several other clerics and some matrons were added. By a king’s charter of 1208 (10th John), it was to receive sixty shillings annually. It is next heard of, in the Rolls of Parliament, in connexion with a petition of 1314-15 (8 Ed. II.), by the terms of which, and of the reply to it, we can see that there were then some lepers in the hospital but also patients of another kind. It is mentioned by Wendover, under the year 1222, as the scene of a trial of strength between the citizens and the _comprovinciales extra urbem positos_[168]: at that date it stood well in the country, probably near to where the church of St Giles now stands at the end of old High Holborn. The drawing of the hospital on the margin of Matthew Paris’s manuscript shows it as a house of stone, with a tower at the east end and a smaller one over the west porch, and with a chapel and a hall, but probably no dormitories for forty lepers[169]. The other endowed leper-house of the metropolis was the hospital of St James, in the fields beyond Westminster. It was of ancient date, and provided for fourteen female patients, who came somehow to be called the _leprosae puellae_[170], although youth is by no means specially associated with leprosy. This house grew rich, and supported eight brethren for the religious services of the sixteen patients[171]. It is usual to enumerate five, and sometimes six, other leper-hospitals, in the outskirts of London--at Kingsland or Hackney, in Kent Street, Southwark (the Lock), at Highgate, at Mile End, at Knightsbridge and at Hammersmith. But the earliest of these were founded in the reign of Edward III. (about 1346) at a time when the old ecclesiastical leper-houses were nearly empty of lepers. It would be misleading to include them among the medieval leper-houses proper, and I shall refer to them in a later part of this chapter. The example of archbishop Lanfranc at Canterbury and of queen Matilda in London was soon followed by other founders and benefactors. The movement in favour of lepers--there was probably too real an occasion for it to call it a craze--gained much from the appearance on the scene of the Knights of the Order of St Lazarus of Jerusalem. Those knights were the most sentimental of the orders of chivalry, and probably not more reputable than the Templars or the main body of the Hospitallers from which they branched off. If we may judge of them by modern instances, they wanted to do some great thing, and to do it in the most theatrical way, with everybody looking on. What real services they may have rendered to the sick poor, leprous or other, there is little to show. The head-quarters of the order were at Jerusalem, the Grand Master and the Knights there being all _leprosi_--doubtless in a liberal sense of the term. We should be doing them no injustice if we take them to have been Crusaders so badly hit by their vices or their misfortunes as to be marked off into a separate order by a natural line. However, many others enlisted under the banner of St Lazarus who were not _leprosi_; these established themselves in various countries of Europe, acquired many manors and built fine houses[172]. In England their chief house was at Burton in Leicestershire; it was not by any means a great leper-hospital, but a Commandery or Preceptory for eight whole knights, with some provision for an uncertain number of poor brethren--the real Lazaruses who, like their prototype, would receive the crumbs from the high table. The house of Burton Lazars gradually swallowed up the lands of leper-hospitals elsewhere, as these passed into desuetude, and at the valuation of Henry VIII. it headed the list with an annual rental of £250. Their establishment in England dates from the early part of the twelfth century, and although the house at Burton appears to have been their only considerable possession, they are said, on vague evidence, to have enlisted many knights from England, and, curiously enough, still more from Scotland. A letter is extant by the celebrated schoolman, John of Salisbury, afterwards bishop of Chartres, written in the reign of Henry II. to a bishop of Salisbury, from which it would appear that the “Fratres Hospitales” were regarded with jealousy and dislike by the clerical profession; “rapiunt ut distribuant,” says the writer, as if there were something at once forced and forcible in their charities[173]. Coincidently with the appearance in England of the Knights of St Lazarus, we find the monasteries, and sometimes private benefactors among the nobility, beginning to make provision for lepers, either along with other deserving poor or in houses apart. After the hospitals at Canterbury and London (as well as an eleventh-century foundation at Northampton, which may or may not have been originally destined for _leprosi_), come the two leper-houses founded by the great abbey of St Albans. As these were probably as good instances as can be found, their history is worth following. In the time of abbot Gregory (1119 to 1146), the hospital and church of St Julian was built on the London road, for six poor brethren (_Lazares_ or _pauperes Christi_) governed by a master and four chaplains. The mastership of St Julian’s is twice mentioned in the abbey chronicles as a valuable piece of preferment. In 1254 the lands of the hospital were so heavily taxed, for the king and the pope, that the _miselli_, according to Matthew Paris, had barely the necessaries of life. But a century after, in 1350, the revenues were too large for its needs, and new statutes were made; the accommodation of its six beds was by no means in request, the number of inmates being never more than three, sometimes only two, and occasionally only one[174]. The fate of the other leper-house of St Albans abbey, that of St Mary de Pratis for women, is not less instructive. The date of its foundation is not known, but in 1254 it had a church and a hospital occupied by _misellae_[175]. A century later we hear of the house being shared between illiterate sisters and nuns. The former are not called lepers, but simply poor sisters; whatever they were, the nuns and they did not get on comfortably together, and the abbot restored harmony by turning the hospital into a nunnery pure and simple[176]. Similar was the history of one of the richest foundations of the kind, that of Mayden Bradley in Wiltshire. It was originally endowed shortly before or shortly after the accession of Henry II. (1135) by a noble family for an unstated number of poor women, generally assumed to have been _leprosae_, and for an unstated number of regular and secular clerics to perform the religious offices and manage the property. It had not existed long, however, when the bishop of Salisbury, in 1190, got the charter altered so as to assign the revenues to eight canons and--poor sisters, and so it continued until the valuation of Henry VIII., when it was found to be of considerable wealth. In like manner the hospital of St James, at Tannington near Canterbury, founded in the reign of Henry II. for twenty-five “leprous sisters,” was found, in the reign of Edward III. (1344), to contain no lepers, its “corrodies” being much sought after by needy gentlewomen[177]. Another foundation of Henry II.’s reign was the leper-hospital of St Mary Magdalen at Sponne, outside the walls of Coventry. It was founded by an Earl of Chester, who, having a certain leprous knight in his household, gave in pure alms for the health of his soul and the souls of his ancestors his chapel at Sponne with the site thereof, and half a carucate of land for the maintenance of such lepers as should happen to be in the town of Coventry. There was one priest to celebrate, and with him were wont to be also certain brethren or sisters together with the lepers, praying to God for the good estate of all their benefactors. “But clear it is,” says Dugdale, “that the monks shortly after appropriated it to their own use.” However, they were in time dispossessed by the Crown, to which the hospital belonged until the 14th of Edward IV[178]. One of the most typical as well as earliest foundations was the hospital of the Holy Innocents at Lincoln, endowed by Henry I. We owe our knowledge of its charter to an inquisition of Edward III. It was intended for ten _leprosi_, who were to be of the outcasts (_de ejectibus_) of the city of Lincoln, the presentation to be in the king’s gift or in that of the mayor or other good men of the city, and the administration of it by a master or warden, two chaplains and one clerk. In the space of two centuries from its foundation the character of its inmates had gradually changed. Edward III.’s commissioners found nine poor brethren or sisters in it; only one of them was _leprosus_, and he had obtained admission by a golden key; also the seven poor women had got in _per viam pecuniam_. In Henry VI.’s time provision was made for the possibility of lepers still requiring its shelter--_quod absit_, as the new charter said. In the same reign (end of Henry I.) the hospital of St Peter was founded at Bury St Edmunds by abbot Anselm, for priests and others when they grew old and infirm, leprous or diseased. The other hospital at Bury, St Saviour’s, had no explicit reference to leprosy at all. It was founded by the famous abbot Samson about 1184, for a warden, twelve chaplain-priests, six clerks, twelve poor gentlemen, and twelve poor women. About a hundred years later the poor sisters had to go, in order to make room for old and infirm priests. Sometime before his death in 1139, Thurstan, archbishop of York, founded a hospital at Ripon for the relief of “all the lepers in Richmondshire;” the provision was for eighteen patients, a chaplain and sisters. At an uncertain date afterwards the house was found to contain a master, two or three chaplains and some brethren, who are not styled _leprosi_; and from the inquisition of Edward III. we learn that its original destination had been for the relief as much of the poor as the leprous (_tam pauperum quam leprosorum_), and that there was no leprous person in it at the date of the inquisition. The mixed character of hospitals commonly reckoned leper-hospitals is shown by several other instances. St Mary Magdalene’s at Lynn (1145) provided for a prior and twelve brethren or sisters, nine of whom were to be whole and three leprous. St Leonard’s at Lancaster (time of king John) was endowed for a master, a chaplain, and nine poor persons, three of them to be leprous. St Bartholomew’s at Oxford provided for a master, a clerk, two whole brethren and six infirm or leprous brethren; but the infirm or leprous brethren had all been changed into whole brethren by the time of Edward III[179]. So again the Normans’ spital at Norwich was found to be sheltering “seven whole sisters and seven half-sisters.” The leper-hospital at Stourbridge, near Cambridge, was founded for lepers by king John, the one king in English history who cared greatly about his leprous subjects. It was committed to the charge of the burgesses of Cambridge, but it was shortly after seized by Hugo de Norwold, bishop of Ely, and within little more than fifty years from its foundation (7 Ed. I.) it was found that the bishop of Ely of that day was using it for some purposes of his own, but “was keeping no lepers in it, as he ought, and as the custom had been[180].” The ostentatious patronage of lepers by king John, of which something more might be said, was preceded by a more important interposition on their behalf by the third Council of the Lateran in 1179 (Alexander III.). The position of _leprosi_ in the community had clearly become anomalous, and one of the decrees of the Council was directed to setting it right. Lepers, who were “unable to live with sound persons, or to attend church with them, or to get buried in the same churchyard, or to have the ministrations of the proper priest,” were enjoined to have their own presbytery, church, and churchyard, and their lands were to be exempt from tithe[181]. Within two or three years of that decree, in or near 1181, we find a bishop of Durham, Hugh de Puiset, endowing the greatest of all the English leper-hospitals, at Sherburn, a mile or more outside the city of Durham. The bishop was a noted instance of the worldly ecclesiastic of his time. He was accused by the king of misappropriating money left by the archbishop of York, and his defence was that he had spent it on the blind, the deaf, the dumb, the leprous, and such like deserving objects[182]. William of Newburgh has left us his opinion of the bishop’s charity: it was a noble hospital lavishly provided for, “but with largess not quite honestly come by” (_sed tamen ex parte minus honesta largitione_[183]). The hospital of bishop Hugh, dedicated to the Saviour, the Blessed Virgin, St Lazarus, and his sisters Mary and Martha, still exists as Christ’s Hospital, a quadrangular building enclosing about an acre in a sunny valley to the south of the city, with a fine chapel, a great hall (of which the ancient raftered roof existed into the present century), a master’s lodge, and a low range of buildings on the west side of the square for the poor brethren, with their own modest hall in the middle of it. The original foundation was certainly on a princely scale, as things then went: it was for five “convents” of lepers, including in all sixty-five persons of both sexes, with a steward or guardian to be their own proper representative or protector, three priests, four attendant clerks, and a prior and prioress. We hear nothing more of the hospital for a century and a half, during which time it had doubtless been filled by a succession of poor brethren, or sick poor brethren, but whether leprous brethren, or even mainly leprous, may well be doubted after the recorded experiences of Ripon, Lincoln and Stourbridge. Its charter was confirmed by bishop Kellaw about 1311-1316; and in an ordinance of 1349 we still read, but not without a feeling of something forced and unreal, of the hospital ministering to the hunger, the thirst, the nakedness of the leprous, and to the other wants and miseries by which they are incessantly afflicted. But within ninety years of that time (1434) the real state of the case becomes apparent; the poor brethren had been neglected, and the estates so mismanaged or alienated to other uses, that new statutes were made reducing the number of inmates to thirteen poor brethren and two lepers, the latter being thrown in, “if they can be found in these parts,” in order to preserve the memory of the original foundation[184]. To these samples, which are also the chief instances of English leper-hospitals, may be added two or three more to bring out another side of the matter. In the cases already given, it has been seen that the provision for the clerical staff was either a very liberal one at first or became so in course of time. The hospitals, whether leprous or other, were for the most part dependencies of the abbeys, affording occupation and residence to so many more monks, just as if they had been “cells” of the abbey. The enormous disproportion of the clerical staff to the inmates of hospitals (not, however, leprous) is seen in the instances of St Giles’s at Norwich, St Saviour’s at Bury and St Cross at Winchester. The provision was about six for the poor and half-a-dozen for the monks. But even the purely nosocomial part of these charities was in not a few instances for the immediate relief of the monasteries themselves. St Bartholomew’s at Chatham, one of the earliest foundations usually counted among the leper-hospitals, was for sick or infirm monks. The hospital at Basingstoke, endowed by Merton College, Oxford, was for incurably sick fellows and scholars of Merton itself. The leper-hospital at Ilford in Essex was founded about 1180 by the rich abbey of Barking, for the leprous tenants and servants of the abbey, the provision being for a secular master, a leprous master, thirteen leprous brethren, two chaplains and a clerk. St Lawrence’s at Canterbury (1137) was for leprous monks or for the poor parents and relations of monks. St Peter’s at Bury St Edmunds, founded by abbot Anselm in the reign of Henry I., was for priests and others when they grew old, infirm, leprous, or diseased. The instances which have been detailed in the last few pages, perhaps not without risk of tediousness, have not been chosen to give a colour to the view of medieval leprosy; they are a fair sample of the whole, and they include nearly all those leper-hospitals of which the charters or other authentic records are known[185]. It is possible by using every verbal reference to leprosy that may be found in connexion with all the five hundred or more medieval English hospitals in Bishop Tanner’s _Notitia Monastica_ or in Dugdale’s _Monasticon_, to make out a list of over a hundred leper-hospitals of one kind or another. But there are probably not thirty of them for which the special destination of the charity is known from charters or inquisitions; and even these, as we have seen, were not all purely for lepers or even mainly for lepers. As to the rest of the list of one hundred, the connexion with leprosy is of the vaguest kind. Thus, four out of the five hospitals in Cornwall are called lazar-houses or leper-hospitals, but they were so called merely on the authority of antiquaries subsequent to the sixteenth century. The same criticism applies almost equally to the eight so-called leper-hospitals, out of a total of fourteen medieval hospitals of all kinds, in Devonshire. It is clear that “lazar-house” became an even more widely generic term than the terms _lepra_ and _leprosus_ themselves[186]. Thus our doubts as to the amount of true leprosy that once existed in England, and was provided for in the access of chivalrous sentiment that came upon Christendom in the twelfth and thirteenth centuries, tend to multiply in a compound ratio. We doubt whether many of the so-called leper-houses or lazar-houses in the list of one hundred, more or less, that may be compiled from the _Monasticon_, were not ordinary refuges for the sick and infirm poor, like the three or four hundred other religious charities of the country. We know that, in some instances of leper-hospitals with authentic charters, the provision for the leprous was in the proportion of one to three or four of non-leprous inmates. We know that as early as the end of the thirteenth century the _leprosi_ were disappearing or getting displaced even from hospitals where the intentions of the founder were explicit. And lastly we doubt the homogeneity of the disease called _lepra_ and of the class called _leprosi_. As to the foundations of a later age they were no longer under ecclesiastical management, and they seem to have been mostly rude shelters on the outskirts of the larger towns. In 1316 a burgess of Rochester, who had sat in Parliament, left a house in Eastgate to be called St Katharine’s Spital, “for poor men of the city, leprous or otherwise diseased, impotent and poor”--or, in other words, a common almshouse. The remarkable ordinance of Edward III. in 1346, for the expulsion of lepers from London, seems to have been the occasion of the founding of two so-called lazar-houses, one in Kent Street, Southwark, called “the Loke[187],” and the other at Hackney or Kingsland. These are the only two mentioned in the subsequent orders to the porters of the City Gates in 1375; and as late as the reign of Henry VI. they are the only two, besides the ancient Matilda’s Hospital in St Giles’s Fields, to which bequests were made in the will of Ralph Holland, merchant taylor[188]. Another of the suburban leper-spitals was founded at Highgate by a citizen in 1468[189], and it is not until the reign of Henry VIII. that we hear of the spitals at Mile End, Knightsbridge and Hammersmith[190]. By that time leprosy had ceased to be heard of in England; but another disease, syphilis, had become exceedingly common; and it is known that those spitals, together with the older leper-hospitals, were used for the poorer victims of that disease. Stow is unable to give the exact date of any of these foundations except that at Highgate. He assumes that the others were all built on the occasion of the ordinance of 20 Edward III.; but it is probable that only two of them, the Lock and the Kingsland or Hackney spital were built at that time[191]. An early instance of a leper-spital or refuge apparently without ecclesiastical discipline is mentioned in a charter roll of 1207-8, in which king John grants to the leprosi of Bristol a croft outside the Laffard gate, whereon to reside under the king’s protection and to beg with impunity. On the roads leading to Norwich there were four such shelters, outside the gates of St Mary Magdalene, St Bennet, St Giles and St Stephen respectively; these houses were each under a keeper, and were supported by the alms of the townsfolk or of travellers; only one of the four is alleged to have had a chapel attached. The date of these is unknown, but they were probably late. On the roads leading from Lynn, there were three such erections, at Cowgate, Letchhythe and West Lynn, which are first mentioned in a will of 1432. These non-religious and unendowed leper-spitals were probably rude erections on the outskirts of the town, at the door of which, or on the roadside near, one or more lepers would sit and beg. The liberty of soliciting alms was one of their privileges, only they were not allowed to carry their importunity too far; hence the ordinance of most countries that the lepers were not to enter mills and bake-houses; and hence some ordinances of the Scots parliament limiting the excursions of the leper folk. One of the most considerable privileges to lepers was granted to the lepers of Shrewsbury in 1204 by king John, who did not lose the chance of earning a cheap reputation for Christian charity by his ostentatious patronage of the _pauperes Christi_: they were entitled to take a handful of corn or flour from all sacks exposed in Shrewsbury market. Leper-houses in Scotland and Ireland. Most of the leper-spitals of Scotland would appear to have been of the poorest kind, unendowed and unprovided with priests. The richest foundation for lepers in Scotland was at Kingcase, near Prestwick in Ayrshire, endowed with lands and consisting of a hospital of eight beds. One or more leper-hospitals were built by the rich abbeys on the Tweed (at Aldcambus in Berwickshire and probably at another place). Another great ecclesiastical centre in Scotland, Elgin, had a leper-house at Rothfan, with accommodation for seven lepers, a chaplain, and a servant. After these, the Scots leper-houses may be taken to have been mere refuges, in which the lepers supported themselves by begging. One such secular hospital was in the Gorbals of Glasgow, founded in 1350. Liberton, near Edinburgh, is supposed to mean Leper-town, and to have been a resort of the sick on account of its medicinal spring. The hospital at Greenside, then outside Edinburgh, was built in 1589. There was a leper-spital outside the Gallow-gate of Aberdeen, on a road which still bears the name of the Spital. Similar shelters may be inferred to have existed at Perth, Stirling, Linlithgow and other places. James IV., in his journeys, used to distribute small sums to the sick folk in the “grandgore” (syphilis), to the poor folk, and to the lipper-folk, “at the town end[192].” There were some leper-hospitals in Ireland, but it is not easy to distinguish them in every case from general hospitals for the sick poor. Thus the hospital built by the monks of Innisfallen in 869 is merely called _nosocomium_, although it is usually reckoned an early foundation for lepers in Ireland. A hospital at Waterford was “confirmed to the poor” by the Benedictines in 1185. St Stephen’s in Dublin (1344) is specially named as the residence of the “poor lepers of the city” in a deed of gift about 1360-70; a locality of the city called Leper-hill was perhaps the site of another refuge. Lepers also may have been the occupants of the hospitals at Kilbrixy in Westmeath (St Bridget’s), of St Mary Magdalene’s at Wexford (previous to 1408), of the house at “Hospital,” Lismore (1467), at Downpatrick, at Kilclief in county Down, at Cloyne, and of one or more of four old hospitals in or near Cork. The hospital at Galway, built “for the poor of the town” about 1543, was not a leper-house, nor is there reason to take the old hospital at Dungarvan as a foundation specially for lepers[193]. The Prejudice against Lepers. It will have been inferred, from many particulars given, that the segregation of lepers in the Middle Ages was far from complete, and that many ministered to them without fear and without risk. The same hospital received both _leprosi_ and others, the hospitals were served by staffs of chaplains, clerks and sometimes women attendants; and yet nothing is anywhere said of contagion being feared or of the disease spreading by contagion. The experience of these medieval hospitals was doubtless the same as in the West Indies and other parts of the world in our own day. It is true that the medical writers pronounce the disease to be contagious, _ut docet Avicenna_; but the public would seem to have been unaware of that, and they certainly lost nothing by their ignorance of the medical dogma, which, in the text-books, is merely the result of a concatenation of verbalist arguments. At the same time it is clear that there was a certain amount of segregation of the leprous. The inmates of the hospital at Lincoln are significantly described as “de ejectibus” of the city. The third Lateran Council based one of its decrees upon what must have been a common experience, namely, that lepers were unable to mix freely with others, and that they were objected to in the same church, and even as corpses in the same churchyard. There are some particular indications of that feeling to be gathered from the chroniclers. One of the most remarkable histories is that of a high ecclesiastic in the pre-Norman period. In the year 1044, Aelfward, bishop of London, being stricken with leprosy (_lepra perfusus_) sought an asylum in the monastery of Evesham, of which he was the prior. The monks may have had more than one reason for not welcoming back their prior; at all events they declined to let him stay, so that he repaired to the abbey of Ramsey, where he had passed his noviciate and been shorn a monk. He carried off with him from Evesham certain valuables and relics; and his old comrades at Ramsey, undeterred by his leprosy or counter-attracted by his treasures, took him in and kept him until his death. The incident can hardly be legendary for it is related in the annals of Ramsey Abbey by one who wrote within a hundred years of the event[194]. Another case, which may also be accepted as authentic, is given by Eadmer in his _Life of Anselm_. Among the penitents who sought counsel and consolation of Anselm while he was still abbot of Bec in Normandy, with a great name for sanctity, was a certain powerful noble from the marches of Flanders. He had been stricken with leprosy in his body, and his grief was all the greater that he saw himself despised beneath his hereditary rank, and shunned by his peers _pro obscenitate tanti mali_[195]. Besides such notable cases, we find more evidence in the ordinances of the hospital of St Julian at St Albans, which have been preserved more completely than those of any other leper-house. Forasmuch as the disease of leprosy is of all infirmities held the most in contempt, the unfortunate person who is about to be received into the St Albans house is directed to work himself up into a state of the most factitious melancholy; he is reminded, not only of the passage in Leviticus about “Unclean, unclean!”, but also of the blessed Job, who was himself a leper (in the 14th century his boils became identified with the plague, and in the end of the 15th century the patriarch was claimed as an early victim of the _lues venerea_); and further of the verse in the 53rd of Isaiah: “Et nos putavimus eum leprosum, percussum a Deo, et humiliatum[196].” The St Albans house, with its six beds, appears to have been carefully managed, and its inmates well provided for; but the unreal atmosphere of the place had been too much for the leprous or other patients of the district; for we find it on record that they could hardly be persuaded to don its russet uniform, and submit themselves for the rest of their lives to its discipline. There can be no question, then, that persons adjudged leprous were shunned, driven out or ostracised by public opinion, and even legislated against. The reality of these practices should not be confounded with a real need for them. Least of all should they be ascribed to a general belief in the contagiousness of the disease. In practice no one heeded the medical dogma of leprous contagion, because no one attached any concrete meaning to it or had any real experience of it. There was prejudice against lepers, partly on account of Biblical tradition, and partly because the “terribilis aspectus” of a leper was repulsive or uncanny. Further, in genuine leprosy, the most wretched part of the victim’s condition was not his appearance (which in a large proportion of cases may present little that is noticeable to passing observation), but his unfitness for exertion, his listlessness, and depression of spirits, owing to the profound disorganisation of his nerves. A leprous member of a family would be a real burden to his relatives; and in a hard and cruel age he would be little better off than the stricken deer of the herd or the winged bird of the flock. To become a beggar was his natural fate; and as a beggar he became privileged, by royal patent or by prescription, while beggars in ordinary were under a ban. It is undoubted that the privilege of begging accorded to lepers was abused, and was claimed by numbers who feigned to be lepers[197]. The one severe edict against lepers in England was the ordinance of Edward III. for the exclusion of lepers from London in 1346; it is clear, however, from the text of the ordinance that the occasion of it was not any fixed persuasion of the need for isolating leprous subjects, but some intolerable behaviour of lepers or of those who passed as such. The mayor and sheriffs are ordered to procure that all lepers should avoid the city within fifteen days, for the reason that persons of that class, as well by the pollution of their breath, etc. “as by carnal intercourse with women in stews and other secret places, detestably frequenting the same, do so taint persons who are sound, both male and female, to the great injury etc.[198]” That is the old confusion which we have already noticed in Bernard Gordonio and Gilbert; it is an edict against _lepra_ in its generic sense, and against the same class that William Clowes characterizes so forcibly in his book on the _morbus Gallicus_ in 1579. At a date intermediate between those two, in 1488, an order was made by the provost of Paris, that “lepers” should leave the city; but that is too late a date for leprosy, although not too early for syphilis. On the 24th August, 1375, the porters of the City Gates were sworn to prevent lepers from entering the city, or from staying in the same, or in the suburbs thereof; and on the same date, the foreman at ‘Le Loke’ (the Lock Hospital in Southwark) and the foreman at the leper-spital of Hackney took oath that they will not bring lepers, or know of their being brought, into the city, but that they will inform the said porters and prevent the said lepers from entering, so far as they may[199]. When all word of leprosy had long ceased in England the porters of the City Gates had the same duties towards beggars in general. Thus in Bullein’s _Dialogue_ of 1564, the action begins with a whining beggar from Northumberland saying the Lord’s Prayer at the door of a citizen. The citizen asks him, “How got you in at the gates?” whereupon it appears that the Northumbrian had a friend at Court: “I have many countrymen in the city,” among the rest an influential personage, the Beadle of the Beggars[200]. While it cannot be maintained that lepers were tolerated or looked upon with indifference, yet it was for other reasons than fear of contagion that they were objectionable. The prejudices against them have been already illustrated from periods as early as the eleventh century. They were, to say the least, undesirable companions, and in certain occupations they must have been peculiarly objectionable. Thus, on the 11th June, 1372, in the city of London, John Mayn, baker, who had often times before been commanded by the mayor and aldermen to depart from the city, and provide for himself some dwelling without the same, and avoid the common conversation of mankind, seeing that he the same John was smitten with the blemish of leprosy--was again ordered to depart[201]. It does not appear whether the baker departed that time, nor is there any good diagnosis of his leprosy; there was certainly a prejudice against him, but the occasion of it may have been nothing more than the eczematous crusts on the hands and arms, sometimes very inveterate, which men of his trade are subject to. It is clear also from a singular case in the _Foedera_, that a false accusation of leprosy was sometimes brought against an individual, perhaps out of enmity, like an accusation of witchcraft. In 1468 a woman accused of leprosy appealed to Edward IV., who issued a chancery warrant for her examination. The writ of 3rd July, 1468, is to the king’s physicians, “sworn to the safe-keeping of our person,” William Hatteclyff, Roger Marschall, and Dominic de Serego, doctors of Arts and Medicine; and the subject of the inquisition is Johanna Nightyngale of Brentwood in Essex, who was presumed by certain of her neighbours to be infected by the foul contagion of _lepra_, and for whose removal from the common intercourse of men a petition had been laid in Chancery. She had refused to remove herself to a solitary place, _prout moris est_; the physicians are accordingly ordered to associate with themselves certain legal persons, to inquire whether the woman was leprous, and, if so, to have her removed to a solitary place _honestiori modo quo poteris_. On the 1st of November, 1468, the court of inquiry reported that they found the woman to be in no way leprous, nor to have been. The woman had been brought before them: they had passed in review twenty-five or more of the commonly reputed signs of _lepra_, but they had not found that she could be convicted of leprosy from them, or from a sufficient number of them; again, passing in review each of the four species of lepra (_alopecia_, _tinia_, _leonina_, and _elephantia_) and the forty or more distinctive signs of the species of _lepra_, they found not that the woman was marked by any of the species of _lepra_, but that she was altogether free and immune from every species of _lepra_[202]. Laws against Lepers. The ordinance of 21 Edward III. (1346) against the harbouring of lepers in London is the only one of the kind (so far as I know) in English history; the Statutes of the realm contain no reference to lepers or leprosy from first to last; the references in the Rolls of Parliament are to the taxing of their houses and lands. The laws which deprived lepers of marital rights and of heirship appear to have been wholly foreign; in England, leprosy as a bar to succession was made a plea in the law courts. It appears, however, that a law against lepers was made by a Welsh king in the tenth century[203]. It is not easy to realize the state of Welsh society in the tenth century; but we know enough of it in the twelfth century, from the description of Giraldus Cambrensis, to assert with some confidence that “leprosy” might have meant anything--perhaps the “lepra Normannorum[204].” In Scotland the laws and ordinances, civil and ecclesiastical, against lepers have been more numerous. In 1242 and 1269, canons of the Scots Church were made, ordering that lepers should be separated from society in accordance with general custom. In 1283-84, the statutes of the Society of Merchants, or the Guildry, of Berwick provided that lepers should not enter the borough, and that “some gude man sall gather alms for them.” In 1427 the Parliament of Perth authorised ministers and others to search the parishes for lepers[205]. We conclude, then, that little was made of leprosy by English legislators (rather more by the Scots), just as we have found that in the endowment of charities, the leprous had only a small share, and that share a somewhat exaggerated one owing to the morbid sentimentality of the chivalrous period. The most liberal estimate of the amount of true leprosy at any time in England would hardly place it so high as in the worst provinces of India at the present day. In the province of Burdwan, with a population of over two millions, which may be taken to have been nearly the population of England in the thirteenth century, there are enumerated 4604 lepers, or 2·26 in every thousand inhabitants. But even with that excessive prevalence of leprosy, and with no seclusion of the lepers, a traveller may visit the province of Burdwan, and not be aware that leprosy is “frightfully common” in it. In medieval England the village leper may have been about as common as the village fool; while in the larger towns or cities, such as London, Norwich, York, Bristol, and Lincoln, true lepers can hardly have been so numerous as the friars themselves, who are supposed to have found a large part of their occupation in ministering to their wants. A rigorous scepticism might be justified, by the absence of any good diagnostic evidence, in going farther than this. But the convergence of probabilities does point to a real prevalence of leprosy in medieval England; and those probabilities will be greatly strengthened by discovering in the then habits of English living a _vera causa_ for the disease. Causes of Medieval Leprosy. What was there in the medieval manner of life to give rise to a certain number of cases of leprosy in all the countries of Europe? Granting that not all who were called _leprosi_ and _leprosae_, were actually the subjects of _lepra_ as correctly diagnosed, and that the misnomer was not unlikely to have been applied in the case of princes, nobles and great ecclesiastics, we have still to reckon with the apparition of leprosy among the people in medieval Europe and with its gradual extinction, an extinction that became absolute in most parts of Europe before the Modern period had begun. Of the “importation” of leprosy into Britain from some source outside there can be no serious thought; the words are a meaningless phrase, which no one with a real knowledge of the conditions, nature and affinities of leprosy would care to resort to. The varying types of diseases, or their existence at one time and absence at another, are a reflex of the variations in the life of the people--in food and drink, wages, domestic comfort, town life or country life, and the like. No one doubts that the birth-rate and the death-rate have had great variations from time to time, depending on the greater or less abundance of the means of subsistence, on overcrowding, or other things; and the variation in the birth-rate and death-rate is only the most obvious and numerically precise of a whole series of variations in vital phenomena, of which the successions, alternations, and novelties in the types of disease are the least simple, and least within the reach of mere notional apprehension or mere statistical management. The apparition and vanishing of leprosy in medieval Europe was one of those vital phenomena. It may be more easily apprehended by placing beside it a simple example from our own times. The pellagra of the North Italian peasantry (and of Roumania, Gascony and some other limited areas) is the nearest affinity to leprosy among the species of disease. Strip leprosy of all its superficial and sentimental characters, analyse its essential phenomena, reduce its pathology to the most correct outlines, and we shall find it a chronic constitutional malady not far removed in type from pellagra. In both diseases there are the early warnings in the excessive sensibility, excessive redness and changes of colour, at certain spots of skin on or about the face or on the hands and feet. In both diseases, permanent loss of sensibility follows the previous exaggeration, blanching of the skin will remain for good at the spots where redness and discoloration were apt to come and go, and these affections of the end-regions of nerves will settle, in less definite way, upon the nervous system at large,--the cerebro-spinal nervous system, or the organic nervous system, or both together. What makes leprosy seem a disease in a different class from that, is the formation of nodules, or lumps, in the regions of affected skin in a certain proportion of the cases. If leprosy were all anaesthetic leprosy, its affinities to pellagra would be more quickly perceived; it is because about one-half of it has more or less of the tuberculated character that a diversion is created towards another kind of pathology. But the fact that some cases of leprosy develop nodules along the disordered nerves does not remove the disease as a whole from the class to which pellagra belongs. In both diseases we are dealing essentially with a profound disorder of the nerves and nerve-centres, commencing in local skin-affections which come and go and at length settle, proceeding to implicate the nervous functions generally, impairing the efficiency of the individual, and bringing him to a miserable end. The two diseases diverge each along its own path, leprosy becoming more a hopeless disorder of the nerves of tissue-nutrition, and so taking on a structural character mainly but not exclusively, and pellagra becoming more a hopeless disorder of the organic nervous system (digestion, circulation, etc.) with implication of the higher nervous functions, such as the senses, the intellect, and the emotions, and so taking on a functional character mainly but not exclusively. The correlation of structure and function is one that goes all through pathology as well as biology; and here we find it giving character to each of two chronic disorders of the nervous system, according as the structural side or the functional side comes uppermost. What, then, are the circumstances of pellagra, and do these throw light upon the medieval prevalence of leprosy? Pellagra has been proved with the highest attainable scientific certainty to be due to a staple diet of bread or porridge made from damaged or spoilt maize. It followed the