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This chapter, focusing on leprosy in the late medieval Rhineland, aims to illuminate the diverse social realities of those viewed as lepers in medieval Europe. It argues that leprosy did not erase previous social identities, as has sometimes been claimed. Rather, medieval lepers derived their identity from where they lived, and the communities of which they were a part. In addition to examining leper hospitals it considers informal communities of lepers, often located near crossroads. The distinctive vocabulary applied to such communities sheds light on how they lived and were perceived. Overall, the vocabulary used for lepers reveals not only a variety of responses, but a variety of ways in which those designated as lepers could choose to live.

The sources include charters preserved in the archives of Mainz and Darmstadt and the internal records of the leper hospitals of Mainz, Worms and Speyer. A comparison of the statutes of leprosaria and multi-purpose hospitals in the Rhineland indicates that such regulations were primarily affected by hospitals’ legal status as religious institutions, rather than by attitudes towards lepers. The chapter also examines the fifteenth-century letters of diagnosis created by the physicians responsible for the examination for leprosy. These letters reveal both the individual and the collective agency of lepers. The lepers of the Rhineland appear not only in groups, but as individuals: seeking or disputing medical diagnosis, receiving gifts or care, and actively participating in late medieval communities.

The Introduction explains the importance and originality of the volume, presenting examples of the key findings of the chapters. Through comparison with China, it argues that the response to leprosy in medieval Europe was distinguished by the emergence of specialised institutions that did not fully isolate sufferers from society. It addresses the question of when leprosy declined in Europe, and surveys the recent findings of ancient DNA analysis regarding the global distribution of leprosy. A detailed discussion of terminology is included, in terms of both the attention paid by the chapters to the medieval terms used to refer to leprosy and its sufferers, and the fact that the authors adopt different stances on whether to use the word ‘leper’, which closely follows the medieval terminology but denotes stigma today. This issue is complicated by the fact that some people who were described as ‘lepers’ in medieval Europe did not necessarily have leprosy. The Introduction considers the nuances of the individual and collective identities of leprosy sufferers, key themes in the volume. People with leprosy lived both within and outside leprosy hospitals, and they had a wide range of social and religious identities. The Introduction also explores how leprosy sufferers lived between the states of integration and segregation, and provides a detailed overview of the volume.

While leprosy was often associated in the Middle Ages with the stigma of sin, in the twelfth and thirteenth centuries lepers also held a special religious status that made them the ideal recipients of charity and popular devotion. The Church used this dual status of the leper to suit its contemporary needs. What resulted were two distinct but conflicting understandings of the nature of leprosy. However, during the twelfth century, and increasingly in the thirteenth century, leprosy came to be depicted as a disease of the ‘poor of Christ’. Lepers, according to this view, suffered on earth so that they could bypass purgatory. Leprosy came to be seen as an illness miraculously granted by God. This chapter considers one of the decisive factors in this shift: namely, the influence of charismatic religious figures, or saints. The impact of the saints has been largely neglected in the study of social perceptions of leprosy. As foci of great religious devotion, saints played a powerful role in the medieval world. The chapter focuses on that played by one widely known and influential saint, Francis of Assisi. Through a close reading of a selection of sources, as well by situating these sources in their historical context, it charts one man’s influence over social perceptions of what was, and in many ways remains, a highly stigmatised disease.

The fact that leper hospitals emerged in the West around the time of the crusades has led to a belief that there is a close connection between the spread of leprosy and the heightened contacts between East and West during the period of warfare. But the examination of sources of all kinds, from historical, hagiographical and medical texts, to archaeological and iconographic evidence, reveals that the disease was present in both the East and the West prior to the crusades. It is also clear that the sick and the healthy were travelling as pilgrims to eastern holy sites before the initiation of the First Crusade in 1095. While the notion that leprosy was transmitted to the West because of the crusades must therefore be questioned, the extension of the field of observation towards the Byzantine world and the Near East is beneficial to our understanding of leprosy in medieval Europe. The western emulation of eastern attitudes towards assisting lepers is evident. Eastern influences can be discerned in the institutional form of the leper hospital, the palliative medical care offered to lepers and the manner in which lepers were treated as a special category of the sick. Furthermore, cultural influences did not travel in only one direction. The strengthening of the contacts between the various Mediterranean shores that resulted from the crusades led to the cross-influence of charitable models, shaping the foundation of leper hospitals, and the identity and treatment of leprosy sufferers, in both West and East.

By the nineteenth century, most Europeans considered leprosy a matter of the past. When it was ‘rediscovered’ in Europe and the tropical world, people looked to history to inform contemporary understandings of the disease. Using medical journals and textbooks, leprosy histories, policy documents, newspaper articles, and philanthropic publications, this chapter discusses modern perceptions of medieval leprosy. First, it shows how medieval leprosy gained and lost relevance as medical and scientific debates changed over time. The past was reinvented to correspond with the present, in which leprosy’s contagiousness and the supposed efficacy of segregation in medieval Europe were cast as models for modern action. Next, the chapter explores popular conceptions of leprosy. When Europeans began encountering leprosy again in the nineteenth century, writers and medical practitioners drew parallels between medieval Europe and the contemporary tropics, while differentiating them from modern Europe. The contrast drawn between ‘civilised’ modern Europe and its ‘primitive’ medieval past was part of an attempt to preserve the superior, ‘civilised’ identity of Britain, in particular. Leprosy has long been a disease of contradictions, and while modern Europeans were casting medieval Europeans in a negative light, they were also looking to their ancestors for positive inspiration towards philanthropy. Overall, this chapter explores the tension between ‘old’ and ‘new’ ideas about leprosy, showing how perceptions of leprosy’s history, if conflicting, became deeply ingrained in the conceptualisation and management of leprosy in the modern world.

Leprosy has always been very much a socially defined disease. It has been suggested that people with leprosy in the past suffered as a consequence of not only the disease itself, but also the associated stigma. Is there solid evidence that supports this suggestion? This chapter focuses on the evidence of leprosy in skeletons buried in the Middle Ages and beyond. It aims to challenge the traditional view that the management of leprosy in past communities reflected the ostracisation and marginalisation of sufferers. It considers skeletons with leprous bone changes buried in various funerary contexts, primarily in Europe. Previous and often current opinion is that people with leprosy were segregated into leprosy hospitals. However, the majority of skeletons with signs of the disease are not found in leprosy hospital cemeteries, and in some cases the burials appear to indicate that those buried were of ‘special’ or enhanced status, and were certainly not marginalised within the cemetery. This recent research indicates that people with leprosy were probably more accepted within their communities than previously thought.

Leprosy hospitals have received considerable attention from historians in recent years, but there is still comparatively little archaeological research concerning their origins, early form and development over time. There has also been very little work towards synthesising historical data with archaeological evidence. This chapter discusses the origins and development of English leprosy hospitals with reference to the important excavations at Saint Mary Magdalen, Winchester, England, one of the earliest and most comprehensively excavated examples. Research at Winchester, involving the excavation of both building structures and cemeteries, as well as the study of related historical materials, provides an important insight into the development of a particular form of medieval institution, and the identities of those who lived there. Saint Mary Magdalen had relatively humble beginnings as a small hospital for leprosy sufferers, but later developed into a much larger hospital with wider functions, and subsequently became an almshouse. Particular emphasis is placed on the early phases of the site, where analysis of the early cemetery (late eleventh–early twelfth century) indicates skeletal evidence for leprosy in over 85 per cent of excavated examples, a much larger percentage than has previously been recorded at any British site. The graves were anthropomorphic in shape and contained men, women and children, including a medieval pilgrim. This cemetery, together with evidence for associated timber buildings and a chapel, suggests a small, relatively high-status, religious community of leprosy sufferers.

According to the conviction that accounting isn’t necessarily subordinate to economics, the chapter does not deal with accounting practices in a classical sense but aims to highlight the use and value of calculative practices in treatment and research. By examining Elliott Joslin’s principles and practices of diabetes therapy, it shall be shown how he used calculative and administrative techniques as a tool to combine both therapeutic measures and scientific investigation. Drawing on archival materials of the Joslin Diabetes Center, as well as on Joslin’s published manuals, textbooks, and early seminal articles, it shall, first, be shown how Joslin systematised his patient files for comparing cases and evaluating new therapies. Second, it will be shown how Joslin begun to conceptualised diabetes in rather epidemiological and socio-medical terms at the same time, which subsequently led to new collaborations between physicians, government authorities, life insurance companies, and patients bound together by accounting practices. Finally, it is focused on Joslin’s relationship with his patients and how the qualitative and quantitative information he gathered could be used in therapy and research.

Accounting shapes the epistemic possibilities of medical knowledge – and shows how practices seemingly ancillary to bioscience can alter both organisational and human bodies, as well as the available ways for living in each. From the 1950s through 1990s, members of Anabaptist churches, who joined ‘voluntary service’ programmes, were able to ‘volunteer’ as Normal Control human subjects at the US National Institutes of Health. Each group had a ‘unit leader,’ who worked informally as the churches’ local account. As documented in traditional archives and in a publicly available ‘vernacular archive’, Anabaptists were both accounting and being accounted for. First, Mennonites appeared literally in the legers of NIH. They were essential research materials whose time the government purchased for a given price. Accounting practices helped NIH and the Anabaptist churches temporarily to align their missions, which had the structural effect of allowing a moral market in healthy civilian bodies to emerge. Second, Anabaptists were enrolled at NIH in experiments, including studies of metabolism, for which bodies were seen as in vivo accounts through which scientists could record input and output. As a mode of attention in metabolic medicine, accounting clarifies when and how categories such as age, gender, and race, were made real and they reinforced shared social biases. Third, Anabaptists were doing the physical labour of bookkeeping at NIH. Their labour of accounting, and the practices of peer surveillance and discipline it required, enforced the embodied discipline that clinical researchers capitalised upon without needing to assert directly.