Leper Hospitals in Medieval England (with particular reference to the County of Derbyshire). by Margaret Hughes, BA (Hons). A Master's Dissertation, submitted in partial fulfilment of the requirements of the award of the Master of Arts (or Master of Science) degree of the Loughborough University of Technology September 1994 © M. Hughes, 1994 ACKNOWLEDGEMENTS [ would like to acknowledge the loving support and help given by my husband, Graham Hughes, during the writing of this dissertation. Also for the kind attention and consideration of my supervisor, Professor Michael Reed. [would also like to express thanks to the following for allowing me to reproduce maps from their publications: Eileen Bowlt of the Transactions of the London and Middlesex Archaeological Society; [an Mitchell of the Derbyshire Archaeological Society; and D Shaw, Town Clerk and Chief Executive of Chesterfield Borough Council. CONTENTS PAGE NO. Chapter 1. Leprosy: A definition, an historical perspective, 1 and an outline of medical writings upon the subject. Chapter 2. Civil and Ecclesiastical Laws Governing the Life of the 11 Leper. Chapter 3. Leprosy Represented in Art, Literature, Superstition 23 and Folklore. Chapter 4. The Leper Hospitals of Medieval England. 34 Chapter 5. Leper Hospitals in Medieval Derbyshire. 47 LIST OF MAPS Figure 1. Leper Hospitals in the Middle Ages. British Medical Journal, 1890, p.466. Figure 2. Leper Hospitals in Medieval London. Transactions ofthe London and Middlesex Archaeological Society, 1967,21, p.6. Figure 3. Alkmonton, Derbyshire. G.T. Hughes, 1994. Figure 4. Platt of Chesterfield Towne. William Senior, 1633-1637. Figure 5. Derby - 1610. Sketches of Old Derby and Neighbourhood. J. Keys, 1895, p.20. Figure 6. Derby - 1791. Derby: Its Rise and Progress. A. W. Davison, 1906, p.55. Figure 7. Spondon, Derbyshire. G.T. Hughes, 1994. Figure 8. Locko, Spondon. Derbyshire Archaeological Journal, 1991, 111, p.57. The dissertation begins with a modem definition of the disease of leprosy and is followed by an historical account of the development of the disease and ends with an outline of early writings on the subject with references to the sources employed by medieval scholars. The biblical pronouncements of Leviticus conditioned the ecclesiastical laws and social attitudes concerning leprosy and the leper in society, and the civil laws curtailed his freedom of movement and mode of life. Many superstitions surrounded the disease, and the moral and religious overtones are to be found represented in art, church architecture, and literature. The leper hospitals were not hospitals as we understand them today, but a place of refuge and general care. Many hospitals were run by monastic orders, others were by subscription. The number of leper hospitals in England has long been a point of speculation with numbers varying from fifty to over two hundred. They were situated on the outskirts of towns and cities and stringent laws were passed governing the movement and conduct of lepers, their social activities and their family life. In Derbyshire, four leper hospitals are known to have existed, one each in Alkmonton, Chesterfield, Derby and Spondon. The leper hospitals themselves disappeared along with the disease at the end of the fifteenth century. The following is an account of these leper hospitals in Derbyshire which, like those in other parts of the country, either survived as alms houses or vanished without trace leaving only their names behind. For what is the impurity of Leprosy unless it is the sin of lust? s. N. Brody. The Disease of the Soul. Chapter One Leprosy: A Definition. an Historical Perspective. and an Outline of Medical Writings upon the Subject. To appreciate the problems in assessing the extent and severity of leprosy in medieval England and its effects on society, it is first necessary to understand its medical background. As a disease it provoked fear and loathing in society due to a large extent to a common misunderstanding of the nature of the disease and the moral connotations placed upon leprosy by the biblical pronouncements of Leviticus, Job and later the Church Councils. Leprosy is a slow-developing, chronic and infectious disease which rarely kills as a result of the infection itself, but does severely cripple and disfigure the victim. It is a disease which thrives on poor living conditions and deficient diet, in particular low quality salted meat and fish, badly cured meat, and bread made from mouldy or contaminated rye and barley. The disease is caused by the bacteria mycobacterium leprae, a single species with no bacterial variations. The bacteria itself was identified in 1874 by the Norwegian biologist, Gerhard Hanson and often Leprosy is referred to as Hanson's Disease. l The differing types of leprosy are assessed entirely by the victim's degree of immunity to the bacteria. There are two clearly defined forms of leprosy and two less well defined. Lepromatous and Tuberculoid Leprosy are the most severe forms of the disease and reflect both ends of the immunity spectrum. Those with a low resistance to the disease contract the Lepromatous form and those with a high degree of immunity develop Tuberculoid Leprosy. Between these are the less serious forms of Intermediate, which, depending upon the patient's immune system, will develop into either tubercular or lepromatous leprosy at a later stage, or Dimorphous, which shows symptoms of both forms, finally emerging as lepromatous leprosy. The disease has a long incubation period of between two and seven years and occasionally even longer. Communication of leprosy is through nasal and laryngeal droplets, but the disease is not communicable through fomites such as clothing, bedding, commodities or food. It is not hereditary, nor is it transmitted through sexual intercourse. The most severe and infectious form of the disease and the most disfiguring is the lepromatous form. The bacteria causes extensive cell destruction which results in the swelling and yellowing of the face giving a 1 typical "lion face" appearance to the victim. The latter was know to the Greeks as Leprosy Leontiasis. Blindness, destruction of the nose, virtual loss of the voice, nodules erupting over all of the body surface, are further manifestations of this variation of the disease. Tuberculoid Leprosy, although also severe, is the least damaging and infectious form of this disease. Here the severity lies in the damage to the nervous system resulting in loss of sensation to both hands and feet. Persistent and horrifying injuries can be caused through this loss of feeling. Many people are infected by the disease without developing any of the symptoms, or the variation is so mild that the victims recover without knowing they had ever contracted the disease. The latter would have been one of the most common means of unknowingly infecting others and the sufferers would not have been segregated from society. It also illustrates the fact that mycobacterium leprae has a low level of manifestation.2 The fact that leprosy is not a mass disease, coupled with either a very high or very low resistance to the bacteria, suggests that the incidence of leprosy may not have been as high as was previously believed. Identification of the disease has also prevented a true assessment of the extent of the disease in this country. Leprosy as a term was used indiscriminately to describe a variety of skin diseases, complicated by the use of the Greek term Leprae meaning "scaly" and referring to the ulcerous and tubercular skin disease, Lepra. Leprosy had been diagnosed by the Greeks around the turn of the third century BC. Straton, a disciple of Erasistratos, an Alexandrian physician (300- 250 BC), called the disease elephantiasis. Later this was called Graecorum Elephantiasis to distinguish it from Elephantiasis Arabum the disease we know today as elephantiasis which results, among other symptoms, in the grotesque swelling of the legs. 3 Other diseases also known as leprosy were psoriasis, eczema, scrofula, cancer of the skin, and lues, a venereal disease now known as syphilis or lues venerea, characterised by pustules on the skin, scarring and madness. Pellagra and morphea were also often mistakenly diagnosed as leprosy. The former caused redness, cracking and eventual peeling away of the skin, while the latter brought about severe discoloration of the skin, forming yellow, white, brown and even black patches. Since all these conditions were covered by the portmanteau term "leprosy" it is difficult to estimate the true extent of the disease. The earliest known descriptions of leprosy appear in the Indian vedic writings 2 dating from 600-400 BC, but as these were compilations of past masters, the presence of the disease is almost certain to predate this period. Further references to leprosy were to be found in China in 250 BC, in the medical classic, Huang di nei su wen (The Yellow Emperor's Classic of Internal Medicine}.4 The disease is believed to have left China and travelled the trade routes to India, Persia and the Mediterranean. It is also considered possible that Xerxes' armies, when invading Greece in the fifth century BC, brought the disease to Europe. Another source of infection was considered to be Alexander's army returning to Greece in 327-326 BC from its six year campaign in Persia, Afghanistan and India. With the returning army were some 10,000 Asian mistresses who, by order of Alexander, married his soldiers on arrival at Susa, in Persia. Many of the soldiers settled in Palestine in the ten cities known as Decopolis. Others returned to Macedonia, and from there the disease was spread to Italy by Pompey's army, as later described by Pliny the Elder. Further mentions of the disease were made by Lucretius (98-55 BC), Celsus (25 AD), Galen (150 AD) and Arataeus also in the second century AD.