The Domus Leprosorum in Crusader Mr C. SAVONA·VENTURA

The origins of the Military and Hospitaller Order of Saint Lazarus is shrouded in a haze of myth and legend. The problem has been further compoul1ded by the loss of essel1tial dowments from the ravages of wars and time. The Order's presence was a definite rea li ty after the conquest ofJerusalem on the 141h July 1099 by the Crusaders ul1der the leadership of GOdjiTY of Bouillon . The re-orgal1izatiol1 initiated in the hospitaller services available in the Holy City resulted in the setting up of two hospitaller Orders, both adopting the Rule of Saint Augustine.

The first Order, assuming the patronship of St John, became Master of the Hospitallers of St. John [a 1120- d.l l 58/60]. Boyant responsible for hospitaller and hospice services to pilgrims and Roger was succeeded by four relatively unknown Masters - Jean the sick. The second Order assumed the patronship of St Lazarus [a 1131-d-1153], BarthEIEmy [-1153], Itier [-1154], and and was responsible for caring for sufferers of leprosy. Both Orders Hughes de Saint-Pol [-1155-d1157l Hughes was eventually ovmed separate edifices - the former within the walls of the city succeeded by Raymond du Puy [a 1157-d 11 58/601, the l 3 near the Holy Sepulchre ; the latter just outside the walls of the incumbent Master of the Hospitallers of Saint John city. The mid-12 th century saw the formal organization of both TheJerusalem leprosarium, or Domlls LeprosorllJ11 as it came Orders with Statutes being drawn up for the Order ofStJohn by to be called, may have been established prior to the Crusader's Raymond du Puy in -11504 and for the Order of St Lazarus conquest. In 1565, Pope Pius IV in his Bull Inter Assid~lQs possibly by BarthEIEmy in -1154. From the fragmentary acknowledged a link between the Order of Saint Lazarus of survivals of the latter statutes, it appears that these sought the

Jerusalem with Saint Basil the Great IbomcJ2G AD;cltedJ79ADI _ succeeded advice of a rival religious Crusader Order - the Order of the Temple as Bishop of Caesarea 3701 who had established a leprosarium - established about 1118 and receiving recognition by the Council in the city ofPtolemais [now Acre]. These services were gradually of Troyes in 1129. It has been suggested that BarthEIEmy may in expanded by assuming responsibilities for further establishments fact have been a Templar who left the Order to reap the inJerusalem, Bethlehem and Nazareth. A leper hospital had been rewards of ministering to the sick5 Subsequent la te 12 th century established in Jerusalem by the Empress Eudoxia, wife of Arcadius Masters of the Order of St Lazarus inJerusalem included Rainier [383-408 AD]. However a direct link between the 4th century [-1164] , Raymond [-1168], Gerardde MontclarfromAuvergne hospital and the 11 th century establishment remains doubtful. [-1169]' and Bemard [-1185-1186] 6 Jerusalem was lost to The t:wo hospitaller Orders in Jerusalem maintained close Sultan Saladin after the battle of Hattim in October 1187 and contact and may in fact have been initially different elements of the three Orders transferred their headquarters to Acre in 1191 one unit, originally sharing one common Master - Blessed Gerard, after this was regained by the Third Crusade . le Fondateur [accession 1099 - died - 11 20] Under the The first three decades of the 12 th century saw the Order of Mastership of Gerald, the Order of St John, known as Fratres St Lazarus gradually increased its influence in the Holy Land. In Hospitalarii , received formal recognition by Pope Paschall II in 1142 King Fulk ofAnjou donated land inJerusalem to "the church

1113. The Act of Foundation for the Order of St Lazarus was of St. Lazarus alld the COl1vent of the sid, who are wlied misdU " 7. A according to tradition set out by Paschall Il in 1115. Presumably description of the Holy City in 1151 places the leper hospital this would have been similar to that issued two years earlier setting "outside the walls of ]erusalem betweel1 Tanucd's Tower and Saint

up the Order of St John which simply concluded "that th e House Stephen's Gate" 8 In addition a female Convent of St Lazarus of God the Xellodochiul11 for hospiceJ shaU always be ul1der the was extant in Bethany. This convent was extant by 867 A.D . guardianship of the Apostolic See alld the protectiol1 ofBlessed Peter" when it is mentioned by Bernard the Wise in his pilgrim q th 2. Gerald's successor as Master of the Lazarite Order was Boyant travelogue This convent is further mentioned by the 12 century Roger [a 1120-d.l131] who had se rved as Rector to the Hospital chronicl er William of Tyre. The chronicler records that Princess ofStJohn under Blessed Gerald. Raymond du Puy was appointed Sibylla had been raised in this convent under the direction of the

Maltese Family Doctor Ir-Tabib tal-Familja VOLUME 14 ISSUE 02 OECEMBER 2005 67 lo abbess who was the matemal aunt of King Fulk The village of deaee, il1 accOl-dal1ce with apostolic chality, that wherever sa l11al1Y St Lazarus, which belonged to the canons of the Holy Sepulcher, are gathered together under a commol1 way oJliJe that they are able to seems to have been settled by diel1tes, who held been awarded establish a chll/'ch Jor thel11selves with a cemetelY and rejoice iil their Jeuda or fiefs An act of 1129 mentions a holder of a fief, acol1Jrata OWI1 priest, they should be allowed to have them without col1tradictiol1. of St Lazarus, whose daughter was to marry a 11l1t1itus Jamultls of Let them tahe care, howevel; not to hann il1 any way the parochial 11 the canons lights oJ estab!ished churches. FOI- we da 110t wish that what is gra 11 ted N0 contemporary descriptions of the j erusalem leprosarium them on the SCOIT oJ piety SllOUld result in hal111 to othm. We also are extant, but the edifice has been depicted in a 1717 Dutch dedal-e thClt they should 110t be compe!led to pay tithes Jor their gardens map [engraving 20 .0x32 .9 cm] by Franciscus Halma [1653-1722] 01' the pClsture oJ ClnilllClls" I,. entitled De Stadt]ERUSALEM als zy Hedel1daeghs bevol1del1 wordt The Domus leprosorum was run by a master, almost invariably [see figure and de tail below] . This map, showing a traditional a priest, who was assisted by nursing brothers and sisters. In bird's-eye view of]erusalem from the east, was based on an on­ some leper hospitals of the Middle Ages even the master had to site drawing made in 1578. It presents an accurate picture of the be chosen from among the lepers. It is not proved, though it has city as it appeared after the walls were rebuilt by Suleiman the been asserted, that this was the case at j erusalem . It has been Magnificent [1520-1 566], the same walls that surround the Old maintained that Artic1e V of the ancient statutes of the Order City today Numbered legends at the bottom identify 45 holy lays down that "The chieJ oJ the Ol-der shaH be tahen Jrom this side oJ

sites and historicallandmarks. Building No. 37 situated outside the sea; he shaU be a healthy hl1ight" 15 However, this rule mal' in St. Stephen Gate, labeled "Net Zeil,el1 Huys" [Dutch zielzel1huis = fact date to a later period when Pope Innocent IV in 1253 altered 2 hospital, infil111ary] is presumed to depict the Leper's Hospicel the rules of the Order at the request of the brothers to permit "al1Y healthy Imight Jrol11 amongst the bmthers oJ the house" to be appointed master-general since according to Robert de Nantes, Patriarch of]erusalem "all the leper lm igh ts oJthe house oJSt. Lazarus were hilled" in the Battle of Gaza against the Khwarizmians at La Forbie in October 1244 16 This military disaster was further confirmed by the chronicler Matthew Paris u The leper patients were also regarded as brothers or sisters of the house which sheltered them, and obeyed the common rule which united them with their religious guardians. As full 16th Cel1tlllY view oJ the Medieval City ofJel1lsalem members, the inmates thus had a sal' in the management of their and a detail oJ the DOl11us LeprosonllTI affairs. The members of the convent lived in two sets of

[S Ollrcc.' Fra/!ciscus Ha/m(/, 1717 !Jascd 0 11 c. 1578 \'/I.:\\'J accommodation, one for healthy brothers and one for lepers, who ate and slept separately. The day was govemed by a strict horariwll based around services and meals, and punishments The seal of the DOl11us LeprosOI1AI11 shows a priest holding a were imposed on transgressors of the rule. The hospital provided crosier and the inscription "St. Laza111s ofJerusalem" on one side; li ttle or no attempt at curing its sickened inmates funher than on the other side is a leper holding a c1apperwith his face covered fumishing a good diet, comfonable sleeping quarters and relieving

in spots and the insCliption "The seal oJ the lepa" I J . The seal may their suffering by bathing. The hospital probably could be intended to il!ustrate the dual nature of the 12 th century accommodate up to a thousand people under the supervision of Order's organization based on monkish [Chll rch oJ St. Lazarus] the warden, providing them with clothing, shelter and care - and sick [convent oJ the sich] members as defined in King Fulk's though most of these were temporary residents possibly pilgrims 1142 land donation . Unlike the inmates of the hospital run by or migrant lepers visiting jerusalem l8 The hospital code for the the Order of Saint john who were generally merely needyvisitors; jerusalem leprosarium has not survived, but it probably was the lepers cared for by the leprosarium run by the Lazalite Order similar to Ancient rules of the Leper Hospital of Saint Mary were condemned to perpetual sec1usion from the outside world. Magdalene in Dudstone just west of Gloucester, U.K amibuted Such was the degree of sec1usion imposed on lepers that the to Bishop Ivo of Chartes [d.l1l5]. The Saint Mary Magdalene third Lateran Council of 11 79 found it necessary to comment Leprosmium in Dudston was not managed by the Order of Saint that "AlthOLlgh the Apostles says that we SllOlLid pay greater honour to Lazarus, but was dependant on the Llantony Priory whose our weaher mel11bers, certain ecdesiastics, seehing what is their OWI1 followers adopted the Augustinian Rule . It was founded in 11 27 and not the things oJ }CS1IS Christ, da not allow lepas, who connot and housed 13 lepers. dwell with the healthyorcome to church with othm, to have theil'owl1 The Dudston constitutions were plimarily intended to create churches and cemetelies or to be helped by the ministlY oJ their own good order and a purposeful life in a complex residential pliests. Sil1ce it is recognized that th is is JarJml11 CllIlstian piety, we institution. Theywere not concemed with medical requirements.

68 VOLUME 14 ISSUE 02 DECEMBER 2005 Maltese Family Doctor It-Tabib tal-Familja The regulations thus fostered a monastic pa[[em in the leper fortifications of Acre in the 1250s. In Acre, the lazarite community. Male and female parienrs followed regular schedules continued succoring lepers and maintainecl their military duties that included frequenr prayer and periodic silence. Men and in the clefense of the Holy land. In 1255 Pope Alexander IV women were ro avoid becoming romanrically involved with one spoke of "a convent ofl1obles, of active kn ights and othm both healthy another, and members were forbidden ra run about al1d leprous,Jor the purpose of driving out the enemies of the Christia n unaccompanied. C!othes were uniform; food was plenriful with nal11e"; while in 1259, Matthew Paris includecl the l azarites

meat being supplied three times a week, though occasional fasting among the "defenders of the c1wrch fighting il1 Acre" 15 The l azarite was prescribed. A formal promise of stabili ty was required and knights actively participated in a number of local ancl general discip!inary measures were specified. Allowance for physical campaigns against the forces of Islam including the Banle of Gaza infirmi ty was however made and the bedridden were granred [1244], the Seventh Crusade in Egypt [1248-1250], the Syrian special privileges l 9 Campaign [1250-1254]. The lazarite Order also became involved The DomL1S lepmsorum received all leper patienrs whatever with inter-Orders political conflictsl6 their social status. The Livre au Roi , the legal code of the Latin While maintaining its convent in Acre, the Orcler in 1254 kings drawn up c.l198-1205 , required any knight with leprosy transferred its Magisterial headquarters ro France with the consent ro join the convenr of St. Lazarus "where it is established that people of Pope Alexander IV and King Saint louis IX of France. This

with sLlch iIlness should be" 10 Similarly, the rules of the Order of anticipatecl the evenrual fall of the last Crusader ou tpost in the the Temple required any knight infected with leprosy ro leave Holy Land H The final dea th ro ll ro th e Crusader Kingdom of the respective Order and join the brethren of Sainr Lazarus. J erusalem came in April 1291 when the Saracen army under the Templar Rule No. 443 in the Regle du Temple states that "Wh en it leadership of Sultan Khalid laid siege ro Acre . In spite of a spite befalls any bmther that, by the will of Qur lard, he contracts lepmsy of the bravery of the defending forces, the last latin stronghold and the thing is pmven, the worthy mm of the house should admonish fell ro the Saracen onslaught on the 14th May All the mi!itary him and ask him to l-equ est pennission to leave the hOLlse and ga to brethren of the Order ofSainr l azarus presenr at Acre were killed

Saint Lazarus, and take the habit of a bmther of Saint La zants" II during the defense. Grandmaster Hugues de Revel [1258-1277] of the Order ofSainr The earlier transfer of the Magisterial headquarters of the John established the statute that "if in any COUl1tlY there be a Brother Order to westem Europe before the expulsion from Acre enabled who is a lepel; he l11ay 11 0t wear the Habit fml11 that til11 eforward, al1d it ro survive throughout the centu ries in spite of several a[[empts l11ay 110t col11e al11ol1g the Brethren, but he should be provided with at incorporating its holdings with politically more powerful

food al1d clothing" 12 Orders The Military and Hospitaller Order of Saint l azarus of The increasing presence of leper knights in the Order and Jerusalem has during the last cenrury expanded its philantrophic the changing politics in the Holy land after 1123 required the activities on a worldwide level, inclusive the Maltese Islands. The setting up of a military fraction of the Order of St. l azarus with Order maintains its contribution in the fight against leprosy in the aim of conrributing rowards the defense of the Holy l and countries stil! plagued by the infection. from the forces of Islam . Saint Bemard of Clairvaux may well have had the l azarite knights in mind when in 1129 he admonished Crusader knights "to hear matil1s al1d the whole of the divil1e service, il1 accordal1ce with cal1o l1i cal institutiol1 and the wstOI11 of the regular mastm of the holy city. For that reasol1 it is especially owed by you, ve l1 erable bmthers, sin ce despising the light of the present life, being contemptuous of the tonl1ent which is of your bodies,YO Ll have }Jml11ised il1 pCl'petuity to hold cheap wordly l11atters for the love of God: restolTd by the divine jlesh, and col1seaated, en lightelled al1d CO l1fi l111ed il1 the Lord's precepts, aftel' the COI1SUl11ptiO I1 of the divine l11ystelY 110 one should be afmid to fight, but be prepa red

for the croW I1 " B The Ba[[le of Ha[[im at Tiberias in 1187 was ro be the tuming St. Louis Hospital,jcnlsalel11 point for the Crusader Kingclom ofJerusalem and Sultan Saladin pressed his aclvanrage to re-conquer Jerusalem. With rare mercy, Salaclin allowecl the garrison ofJerusalem ro march out in three The Jerusalem DOI11LlS Leprosorwn run by the Order of Saint parties from the postern near Saint lazarusH The Order of St. lazarus su ffered from the ravages of tim e and Islam occupation Lazarus, rogether wi th the other Crusader forces, transferred its throughout the cenruries. The area now hosts the forty-four becl heaclquarters ro Arce, where it owned a hospi tal and convent St. Louis Hospital that serves as a hospice for persons with outsicle the city walls. The buildings were incorporared inro the advanced disease and is sponsored by the French Sisters of St. northern suburb of Montmusard after l ouis IX extended the Joseph.

Maltese Family Doctor [t-Tabib tal-Familja VOLUME 14 ISSUE 02 DECEMBER 2005 69 imported by immigrants or foreign workers arriving from endemic areas. Similarly in , leprosy has been more or less sufficiently controlled to enable the closure of the last leprosarum at Hal Ferha Estate in Gharghur The Grand Priory of Malta of the Order of St. Lazarus had regularly maintained its traditional support to the leprosaurum in Malta and in countries where the disease is stil! partieularly rife, sueh as Kenya and Tanzania. The inereasing influx of immigrants from Northem Afriean regions stil! at risk of leprosy requires the Maltese medieal body to remain vigilant for the clinieal signs of this ehronie infeetive disorder partieularly Hanscl1 Hospital, ]crusalcl11 during the indeterminate stage. The earliest visible lesion of leprosy is usually a poorly defined slightly pink or hypopigmented ] erusalem stil! hosts a Leprosy Centre ealled Hansen Hospital macule 1-2 cm diameter. This is usually associated with varying with thiny beds, even though leprosy today is rare and non­ anaesthesia in the extremities. This stage may heal spontaneously endemic in Israel. However, cases of leprosy are invariably or progress to several distinet later forms.

References Courtesyof: Etemal Word Television Network hup://\V\vwe1VlIl.Col1ll laccessed 9'h May 20051 I C Savona-Venrura: The first hospital of the Order of St. john of jelUsalem. /t-Tabib lili-Familja - )ollnwl of the Malta College of Family " j. Riley-Smith: Hospitallas. Tlre HistOlY of the O,'der of Soint)011ll. Doctors, 1999, 17p.17-21 Hambledon Press, London, 1999, p.22-24

E.E. Hume : Medical Worh of the Knights Hospitallm of Saint John of 10 D. Marcombe, 2003: a/'. cit., p.13-14 )erllsalel11.john Hopkins Press, Baltimore, 1940, p.26; jj. Algranr,j. 17 H. Nicholson: Extmcts frol1l tlre clrronicles of Mallhm Pmis relating to Beaugourdon: An1l0lial of the Militmy and Hospitalla Order of Saint the Templm's, Hospitallm, and Twtonie Knights translateel from the Rolls Lazanls ofJcnjsalcl1I. van den Akker, Dclft, 1983, p.464-465. Selies editions by Helen Nicholson . 1989 [Intemet site: MV\vcjac.uk

3 JJ Algranr,j. Beaugourdon, 1983:op. rit. , p.337. accessed 24'" December 20041' Matthew Paris: Hores Histol'ianll11 [taken from H. R. Luard, Rolls Selies 95, London, 3 vols, 1890, vol. ; E.j. King: The Knights Hosp'tallers in the Holy Land. Methuen, London, 2p.2721. p.324-328 IH D. Marcombe, 2003 of!. eit, p9 , D. Marcombe: Leper )(nights. The Order of St Lazw11s ofJel1lsalem in England, 1150-]544. Boydel! Prcss, Woodbrige [UKI, 2003, p.8-9; M. " Registl1l111 Magl1ll1l1 is PR.O., Ms. C 11511< 2/6683 (formerly cal!ed C Barber: The Order of St LazalUS and the Crusades. The CatllOlic Histolical 115/ A 1) : as reported by EJ Kealey: Medieval MediCl11e. A Social Revie\V,july 1994, 80[3Ip.439-456. HistOlY of Anglo-Nol1l1an Medicinc.). Hopkins University Press, Baltimore, p.l08-109, 200-201. o JJ Algranr,j. Beaugourdon, 1983: op. cil., p.464-465 10 A.A. Bcugnot led.l: Le Livl'e au Roi . Assises de la Haute COIII; Rccueil A. de Marsy [ed.l : Fragmenr d'un Cartulaire de l'Ordre de Sainr-Lazare eles HisWiens des Croisodcs, Lois. Paris, 1841, lp.636-637; D. en Terre Sainre . Archives de /'Orient Lalin, 2 Paris, 1884 [reprint: New Marcombe, 2003 01'. cit, p.l I York, 19781. pl23-124 21 H. de Curzon [ed.1 :- La Reglc c/u Tel1lplc. Societe de I'Histoire de 8 JJ Algran t,j. Beaugourdon , 1983 "[! cit, p.330 France, Paris, 1886, p.239-240

, TI1C Voyagc of BCI'Iwnl t/, e Wise A.D. 867. In: T Wlight [ed. l: Ead y tral'e/s " E.E. Hume, 1940: of!. cit., p.62 in P(jlestinc. Dover Publ, New York. 2003 loriginally publ!shed: H.G. Bohn, London , 18481. p.28 " llaron of Richecourt: A living documenr on Templar Quotes, Statements and Writings. http://\V\\w.ordotcl11pli.orgl 10 j.j. Algranr,j. Beaugourdon, 1983: 01'. eit. , p.330; William ofTyre : (lIIcicnt_tt'lnplw'_Cfllot.:s.htl11 [accessed 8th May 20051. HistOlia l'cnll11 i11 parti/JIIs tmnSl!lwi11is gestanll11, XXlll, l , Pl1lrologio Latino 201, p.890-92, translared by j. llnmdage: Tlre Cl1Isades: A DOCIIl1l cntary " The Old French Conrinuation of William ofTyre, para.57 as HistOlY, Marquette University Press , MHwJllkee, Wl , 1962, p.148-50. translated in PW Edbury: The Conquest oJJenlsolcm and the Thll'(l The Medieval St. Stephen's Gate is today's Damascus Gate. The Cl1lsade. SOllrw iil Trllllslotiol1 . Ashgate, Aldershot , 1998, p.63. ClUsadcr remains of Tancred's Tower [or Goliarh 's Tower] are stil! found " Ej I

70 VOLUME 14 ISSUE 02 DECEMBER 2005 Maltese Family Doctor It-Tabib tal-Familja