Leprosy, now known as Hansen’s disease, is a chronic infection caused by the bacterium Mycobacterium leprae. During the Middle Ages (5th to 15th centuries), this condition reached its highest prevalence across Europe, generating widespread fear and misunderstanding. In the absence of scientific knowledge of the bacterial cause, the response was shaped by limited medical theory and powerful religious interpretations. The approach focused not on a cure, but on managing the afflicted through strict separation and spiritual contemplation. This societal management defined how the affliction was handled throughout the medieval period.
Identification and the Social Stigma
Diagnosis relied on visible, progressive physical manifestations, such as disfiguring skin lesions, nodules, and the eventual loss of extremities due to nerve damage. Medieval society viewed this physical decay not merely as a medical condition but as a sign of spiritual corruption or divine punishment. This moral interpretation amplified the social stigma.
Formal identification was often decreed by local authorities or a priest, not trained physicians. Once confirmed, the person underwent the Separatio Leprosorum, a ritualistic ceremony often called the ‘Mass of Separation.’ During this ceremony, the individual was symbolically declared “dead to the world,” marking their immediate and permanent expulsion from the community.
Medical and Folk Remedies Attempted
Despite the focus on spiritual and social separation, some attempts were made to treat or alleviate symptoms. Academic medicine was influenced by the Galenic humoral theory, which suggested leprosy was caused by an imbalance, specifically an excess of black bile. Treatments based on this theory included therapeutic bloodletting and highly restrictive diets intended to correct the internal humoral balance.
Folk remedies were also common, utilizing easily available substances. These included ingesting herbal mixtures, such as those containing ginger, or externally applying animal fats and mineral ointments containing mercury. Chaulmoogra oil, an extract with a long history in Indian and Chinese traditional medicine, was also sometimes attempted, though its effectiveness was minimal.
The Social Management of Sufferers
The primary societal response was compulsory physical isolation, achieved through specialized institutions known as leper hospitals or lazarets. These facilities were typically established outside city walls, serving the dual purpose of charity and separation from the healthy population. By the 13th century, hundreds, and possibly thousands, of these leprosaria existed across Europe.
These hospitals functioned more like quasi-monastic communities than medical centers, often administered by religious orders. They provided a structured, charitable environment where the afflicted lived under rules, sometimes including vows of celibacy, while receiving basic care and spiritual support. Inhabitants were supported by alms, endowments, and cultivation of small plots of land.
Those who lived outside these institutions were required to wear specific identifying garments and carry a wooden clapper or a bell. The noise served as an auditory warning system, ensuring the person signaled their presence and allowed others to maintain a safe distance.
Legal Status and Loss of Civil Rights
Following the ceremonial diagnosis, the individual’s legal standing was dramatically altered by the concept of “civil death,” or tamquam mortuus—legally considered as if dead. This legal fiction had profound implications beyond physical isolation, as the person was immediately stripped of many fundamental civil rights.
The afflicted could no longer inherit property, testify in court, or enter into new legal contracts. Existing marriages were often dissolved, as the diagnosis was grounds for annulment or divorce under canon law. In many jurisdictions, the individual’s property and assets were immediately forfeited and passed to their heirs, mirroring the process of physical death.
The Edictus Rothari, a 7th-century Lombard law, formalized this exclusion early in the period, requiring the expulsion of the afflicted from their homes and the withdrawal of their power over their possessions.