History

This chapter examines how doctors, nurses and other hospital staff, groups often overlooked in favour of patients, experienced septic finger, wound sepsis and related diseases within the British hospital between 1870 and 1970. The focus on sepsis, as opposed to other types of infection, is significant. Hospital staff were, of course, at risk of contracting all manner of diseases. Yet, widespread concern over sepsis and hospital attempts at prevention and control of sepsis in pre- and post-operative wounds form an often neglected part of the story and span this hundred-year period, as well as recent history with rising antibiotic resistance and hospital mismanagement of infections. While other infections tend to fit more neatly into epidemic periodic cycles, wound sepsis was and still is a continual chronic challenge, one that becomes more important following a serious outbreak or death. Drawing on hospital ledgers and reports, this chapter pays particular attention to occurrences of wound sepsis among staff at four of Britain’s large teaching hospitals, two in England – King’s College (KCH) and St Thomas’ – and two in Scotland – the Royal Infirmaries in Edinburgh (RIE) and Glasgow (GRI).

In This chapter explores the use of innovative technologies for infection control in surgical operations. Beginning with the uptake of surgical gloves in the late nineteenth century, the author explains the relative disinterest of many surgeons by situating their use in the context of other contemporary strategies of infection control. He demonstrates that technological change in surgery and infection control does not happen in a vacuum: understanding of the alternatives to surgical gloves that were not taken up is necessary to explain the evolution of modern surgery and infection control.

Much has been written about the attractions of lepers as agents of redemption in the Middle Ages. They were, above all, regarded as representatives of the tormented Christ, whose appearance quasi leprosus during his Passion became a theme in art and literature. Assumptions about their special status were further encouraged by the belief that they belonged among the fortunate few who would be ‘purified’ of sin on earth through physical suffering, bypassing purgatory and ascending ‘straightway into heaven’. Less attention has been paid to how these ideas influenced responses to leprosy, both before and after the Black Death. This chapter explores the intercessionary role undertaken by hospitalised lepers and their priests in medieval England, and the extent to which it fostered the social and spiritual integration of leprosy sufferers. Adherence to a prayer regimen was facilitated by the availability of a church or chapel, which gave structure to the religious round, but was also necessary for the celebration of Mass. Noting the ubiquity of wayside chapels attached to suburban leper houses, we turn to the spiritual services offered there by sick men and women. Yet funding was precarious, and few leper hospitals survived the upheavals of the fourteenth century unscathed. A decline in the number of functioning institutions undermined the idea of leprosy as a religious calling, and from the 1340s patrons were preoccupied with the sanitary imperatives that prioritised the segregation of lepers. At the same time, other charitable enterprises began to offer competition for financial support.

In the conventional view that fear, revulsion and exclusion characterised the medieval response to leprosy, the clapper served merely to keep patients and bystanders apart from each other. This chapter is part of a broader effort to arrive at a less one-sided and more informed assessment. It presents a comparative analysis of the pictorial evidence provided by some 300 images produced in different parts of Europe, half of which show a clapper. Most of the images illustrate biblical scenes, but they nonetheless reflect contemporary perceptions and mores. The preponderance of two narratives, namely the encounters of Jesus Christ with leprosi and the parable of the rich man and Lazarus, creates a thematic slant. However, these very themes reveal the essential significance of the clapper, as well as of other implements and features that marked leprous patients, particularly wandering leprosi. The common view is that these signs were intended to scare people away and thereby to protect them from horror as well as infection. However, their primary purpose was not to alarm but to alert bystanders, not to trigger fear but to call for mercy – misericordia – for the poor and helpless misellus, or ‘little wretched one’. Indeed, the images discussed in this chapter were aimed at celebrating and stimulating generosity towards the leprous. The common themes were inclusion and attention, not exclusion and rejection.

The identity of the medieval leper is complex, often contradictory, and frequently constructed by a third-party observer. Not all leprosi were the same, and the leper had a different significance to different groups and individuals. The leper’s identity has also been formed through historiography, originally founded upon the narrative of exclusion, long clouding our understanding of the identities of lepers. However, by incorporating the newer historical framework developed by François-Olivier Touati and others, we can begin to reconstruct the leper’s place in medieval society. This chapter takes a comparative approach, exploring how lepers were perceived in Narbonne (southern France) and Siena (Italy), and how these perceptions changed from the foundation of the leper hospitals in each city to the Black Death. One of the overarching discussions concerns whether medieval communities sought to exclude people labelled as lepers. Narbonne’s records concerning lepers are largely transactions or bequests initiated by individuals, though there are also relevant municipal documents. Siena’s sources consist of the legislation preserved in the city’s constitutions from 1262. The documentation in these cases makes for a useful comparison regarding how different groups in society perceived leprosy sufferers. While both cities worked to provide spaces of protection and support for lepers, their approach was different, a picture that is shaped by the nature of the extant sources. Fundamentally, in both cities, lepers were identified collectively as the sick residents of leper houses. However, the sources examined here also enable a more dynamic reconstruction of lepers’ identities.

Food and drink had special significance in medieval leprosy hospitals, since providing sustenance to the sick formed part of both the practice of charity and bodily care. Giving food to the hungry and drink to the thirsty were two of the biblical works of mercy, charitable acts that medieval Christians needed to fulfil to ensure their future salvation. The charters and statutes of northern French leprosy hospitals shed light on dietary arrangements in these institutions, revealing how the consumption of food and drink was a marker of identity for both the leprous and the non-leprous members of the community. These were monastic or quasi-monastic institutions, where communal eating was a central aspect of devotional and social life. The provision of food and drink also formed part of palliative care, with medical texts advising that the leprous should consume mild, moist substances. Yet diet also served to distinguish leprosy sufferers of differing social and religious statuses from one another. Similarly, the diet of the non-leprous monks and nuns, lay brethren, and servants varied according to status. The practical arrangements surrounding meals reflected status and identity, and changed over time. Issues of contamination and contagion also came into play, with leprosy sufferers prohibited from contact with the food and utensils of the non-leprous, but themselves sometimes served contaminated food. The chapter considers how information about diet reveals the range of identities of people with leprosy, and others who resided within leprosy hospitals, as well as the identities of the institutions themselves.

In central medieval sources, lepers are represented as both impure (tainted) and pure (holy) beings. These sources suggest that leprosy was accepted both as a sign of divine election and as a curse. How can we explain this dichotomy in the way that leprosy sufferers were perceived in medieval society? Lepers’ dual representation is even more surprising because they were viewed as Christ’s privileged sick. Why was leprosy seen as a disease that was representative of the sickness and suffering of Christians? And why did lepers benefit from specialised care centres that developed thanks to the generosity of clerical and secular donors? After exploring earlier medieval ideas about leprosy, this chapter examines the complex religious identity of lepers by focusing on miracle accounts associated with the tomb of Saint Thomas Becket at Canterbury, England, written down in the 1170s by Benedict of Peterborough and William of Canterbury. Miracle accounts shed light on medieval attitudes towards sickness and disability, as well as on the identities of those who sought saintly assistance at shrines. The collections of miracles associated with Thomas Becket are unusual because they contain accounts of the healing of lepers, a category of the sick that does not often feature in miracle stories. This chapter considers why lepers feature in Becket’s miracles, and what is signified by the language used to describe them and their suffering. More broadly, it probes the possibility that lepers served as scapegoats for ills in society, as well as being models of Christian suffering.

Referring to textual and iconographic sources, this chapter explores identity within the crusading and hospitaller Order of Saint Lazarus. The Order of Saint Lazarus originated in the leper hospital established by Latin crusaders outside Jerusalem in the twelfth century. This hospital housed a religious community that provided penitential opportunities for pilgrims who offered charity to the resident lepers. As warfare transcended welfare during the last decades of active crusading in the Holy Land, a previously unknown phenomenon developed, the idea of leper knights. The evolution of the community into a crusading militia is documented in the Order’s rule, which states that healthy knights were both to care for the leprous brethren and to fight. The issue of whether leper knights also engaged in combat is addressed in the chapter. In the aftermath of the Latin presence overseas, the brethren of Saint Lazarus in Europe worked to justify the survival of their Order. Hagiography and other common associations with leprosy shaped a renewed identity that lasted until the end of the medieval period. The Order’s persistence testifies to the strength of this brotherhood and the support it elicited. Above all, its evolution in the twelfth and thirteenth centuries reveals how many identities – not just those of the leprous – shifted in the crusading Holy Land. Pilgrims became knights; praying monks became crusading bishops. In this dynamic setting, the identities of lepers were shaped not just by sickness and disability, but also by religious and knightly status, and crusading zeal.

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.