Читать книгу The Greatest Benefit to Mankind: A Medical History of Humanity - Roy Porter - Страница 40

Certain diseases loomed large both in reality and in the public imagination, notably leprosy, now called Hansen’s disease after Armauer Hansen (1841–1912), the discoverer of the bacillus Mycobacterium leprae. Its physical symptoms – scaly flesh, mutilated fingers and toes and bone degeneration, in short ‘uncleanliness’ – made it seem a living death and led to deeply punitive attitudes. The disease has a puzzling history. From as early as 2400 BC Egyptian sources contain references to a skin condition interpreted as leprosy, and 900 years later, the Ebers papyrus mentions a leprous disease seemingly confirmed by Egyptian skeleton evidence. True leprosy probably existed in the Levant from biblical times, but the term was also used for various dermatological conditions producing disfiguring ulcers and sores.

Leprosy became highly stigmatized. Authorized by ancient Levitical decrees, leper laws were strict in medieval Europe. They were forbidden all normal social contacts and became targets of shocking rites of exclusion. They could not marry, they were forced to dress distinctively and to sound a bell warning of their approach. According to the liturgical handbook, the Sarum Use, in thirteenth-century England,

I forbid you ever to enter churches, or go into a market, or a mill, or a bakehouse, or into any assemblies of people.

I forbid you ever to wash your hands or even any of your belongings in spring or stream of water of any kind …

I forbid you ever henceforth to go out without your leper’s dress, that you may be recognized by others …

I forbid you to have intercourse with any woman except your wife…

I forbid you to touch infants or young folk, whosoever they may be, or to give them or to others any of your possessions.

I forbid you henceforth to eat or drink in any company except that of lepers …

They were segregated in special houses outside towns, lazarettos, following the injunction in Leviticus that the ‘unclean’ should dwell beyond the camp. There was also a leper mass, conducted with the victim in attendance, declaring the sufferer to be ‘dead among the living’, and the 1179 Lateran Council ordered them cast out from society, with their own burial places. The only consolation the Church gave was to interpret the leper’s suffering as a purgatory on earth, destined to bring swifter reward in heaven. God, proclaimed de Chauliac, loved the leper; after all, did not the Bible (Matthew 8:3) show Jesus extending his hand, saying ‘be thou clean’?

Leprosy provided a prism for Christian thinking about disease. No less a religious than a medical diagnosis, it was associated with sin, particularly lust, reflecting the assumption that it was spread by sex. In The Testament of Cresseid by Robert Henryson (fl. 1470–1500), the heroine is punished by God with leprosy for her lust and pride. Lepers were thus scapegoated with Jews and heretics in what historians have called a ‘persecuting society’.

From the eleventh century there was a rapid surge in the number of hospitals built to house lepers. By 1226 there may have been around 2,000 in France alone, and in England about 130. By 1225 there were a staggering 19,000 leprosaria in Europe, offering shelter while enforcing isolation. Yet by 1350 leprosy was in decline. The epidemiology of that watershed is much disputed: some have speculated that the Black Death killed so many that the disease died out, others that it might be connected with the rise of tuberculosis, which has a similar but more aggressive pathogen; the TB bacillus could have elbowed out the leprosy. But though the disease waned, its menace remained, becoming a paradigm for later diseases of exclusion, and for persecution generally. Leprosaria were used for the poor and those suspected of carrying infectious diseases. Some became hospitals: on the then outskirts of Paris, the Hôpital des Petites Maisons, near the monastery of St Germain des Prés, founded as a leprosarium, was used for the mentally disordered and for indigent syphilitics. St Giles-in-the-Fields, then just outside London, was a lazaretto and later a hospital, as were the hospitals for incurables built outside Nuremberg.