This book provides a fresh study of leprosy in the medieval world. Its primary focus is on Byzantium, which has commonly been neglected by medical historians, partly because of the lack of modern critical editions and/or translations of Byzantine works. The study also offers numerous comparisons with cases from the medieval West, which sometimes help the reader to contextualise primary sources and associate parallel events in the two regions. However, the book’s title might be considered somewhat misleading, given that the authors do not provide significant new evidence from the West, allowing their Byzantine-centred perspective to prevail instead. Furthermore, they make no attempt to frame their comparative approach against the backdrop of current theoretical discussions,1 and, more importantly, to define the parameters of their methodological approach. For example, evidence from the fifth century is compared with evidence from the fourteenth century in relation to very different societies and geographical regions. In fact, it might have been more helpful if the authors had followed a strictly comparative approach in each chapter, concentrating on various contemporaneous features of interest rather than discussing Byzantine and Western evidence separately. This might also have avoided numerous repetitions.
The book is divided into seven chapters. Chapters Two, Three, and Four concentrate on Byzantium, while the medieval West is treated in Chapters Five, Six, and Seven.
The authors provide a short, but informative introduction to the study of leprosy and how it was understood from a medical point of view. Information on the latter is supplemented by a useful discussion of the discovery of the causative agent of the disease, Mycobacterium leprae, by Gerhard Armauer Hansen in 1873, and the modern effective treatment, which has resulted in a remarkable decrease in cases since the early 1960s. With reference to the title of the book (2, 195), the authors note that ‘Byzantine preachers sometimes called its victims ‘walking corpses’’. However, the expression “κινούμενα λείψανα” features only once in Byzantine sources (ps.-Martyrios, Oratio funebris in laudem Iohannis Chrysostomi, 62.3). It thus gives readers a misleading impression.
Chapter One provides a preliminary discussion of references to the disease in ancient texts from a variety of genres. The longest and most interesting account was written by the Greek medical author Aretaeus, who is said to have “hinted at the possibility of disease seeds” (15), although the original text refers only to the air or an external factor which may play a role in the propagation of the disease (Aretaeus, De causis et signis diuturnorum morborum, 2.13, ed. Hude, 88.4-5).2
Arguably Chapter Two constitutes the study’s most original contribution. The authors collect and discuss references from various non-medical Byzantine sources on the disease, such as sermons by early Church Fathers (Gregory of Nyssa, Gregory of Nazianzos, and John Chrysostom), who emphasised the importance of caring for lepers. In interpreting such texts the authors conclude that “vivid accounts of the large numbers of people driven from their homes […] suggest that the numbers of lepers had been increasing in Asia Minor” (30).3 The most interesting part of the chapter deals with cases after 1204. The authors have managed to locate two references in early fourteenth-century Byzantine sources. One of them, which survives in a poem by Manuel Philes, refers to a man whose health was restored by divine intervention, although he was at an advanced stage of the disease. Such cases show the diachronic presence of what was perceived as miraculous healing during the Byzantine period. There is a noticeable attempt at making some comparisons with the West throughout the chapter. However, in some cases, such as episodes involving Basil of Caesarea and Francis of Assisi kissing lepers, there is no attempt by the authors to bridge the significant gap of nine centuries or the different socio-cultural attitudes affecting the two events.
The third chapter discusses evidence from Byzantine medical sources. There are also special parts devoted to Byzantine divorce law on leprosy and the connection of leprosy with lust. The last part of the chapter focuses on the connection between Byzantine medical treatises and “leprosariums”, and discusses the various references in Greek and Byzantine authors to the connection between elephantiasis and sexual desire, first mentioned by Rufus of Ephesus. The interpretation suffers from small, but irritating and repeated, examples of the use of inappropriate terms, e.g., referring to anonymous Byzantine collections of medical advice as antidotaria.4 The authors rightly identify a case demonstrating the contagious nature of the disease found in the medical encyclopaedia of the sixth-century author Aetios of Amida, which remains partly unpublished. They unquestioningly accept the attribution of this passage to Archigenes (as given in the early Latin printed translation), despite the fact that his name does not appear in all the manuscripts.5
What is more, Byzantine medical literature should for the most part be treated as material derived from compilations of earlier sources and not as necessarily reflecting contemporary medical practice. There are a number of problems: (1) The authors fail to mention or explain why in Alexander of Tralles’ practical medical handbook, written in the sixth century and providing numerous original contributions on dietetics and pharmacology, there is only one brief mention of the disease (Therapeutica, 12, ed. Puschmann, II.543.19). (2) Direct connections between Aretaeus and the late Byzantine vernacular iatrosophion by John Archiatros are not as explicit as they are made out to be (55). (3) The authors correctly observe that Ibn-Sīnā’s treatment of the disease refers to its contagious nature and presents some similarities with the passage found in Aetios (58). However, they present the derivation of Ibn-Sīnā’s text from the supposed text of Archigenes through Aetios as a fact, while the evidence for an Arabic translation of Aetios’ text is at the very least inconclusive. (4) The authors state that “Galen never mentioned an increase in sexual desire” (61), but Galen refers once to unnatural extensions of the pudenda at the onset of the disease (De tumoribus, 14, ed. Kühn, VII.728.4-6). (5) Taddeo degli Alderotti’s reference to concupiscence as a symptom of the disease should not necessarily be assumed to constitute a direct textual link with Aretaeus’ text (64). In the conclusion of the book (157), the authors appear to speculate whether Taddeo knew Greek or had studied in Byzantium without presenting any relevant evidence. (6) In interpreting early mentions of institutions for lepers by the Church Fathers, the authors refer to ‘doctors and assistants who spent their whole lives treating lepers’ (68), although there is no confirmed evidence of such a medicalised institution in Byzantium.
In Chapter Four the authors argue for the continuous functioning of specialised institutions for treating lepers in Byzantium from 400 to 1300. Although there are some confirmed cases throughout the Byzantine period of institutions that hosted lepers among other needy people, the evidence for function of specialist leper asylums is scanty. For example, in the case of the institution in fourth-century Sebasteia (74), the primary source clearly refers to a “πτωχοτροφεῖον” (poor house) hosting (κατὰ φιλοξενίαν) poor people (ἀδυνάτους) as well as those suffering from leprosy (λελωβημένους) (Epiphanius, Panarion, 75.1, ed. Holl, III.333.24-6). Also, it is problematic to argue for continuous function of the Zotikos foundation in Constantinople from the fifth to the thirteenth century and to call it a ‘leper hospital’ (88), since the main primary sources for the early period are hagiographical accounts and none of them can be dated before the tenth or eleventh century. In most cases the sources refer to a home for the elderly (γηροκομεῖον) and there is nothing to suggest the provision of constant medical care or any sort of medicalisation of the institution. This is one of the many cases of overstretching evidence from primary sources, which do not correspond to the authors’ assertions.
The next three chapters mainly summarise earlier secondary bibliography on leprosy in the medieval West by focusing on literary accounts on leprosy (Chapter Five), “leprosariums” (Chapter Six), and the Knights of Lazarus (Chapter Seven). The omission of Guy de Chauliac’s long account, and, in particular, the idea that the disease might be an inherited condition, macula generationis, is regrettable.6 Furthermore, recent important palaeopathological studies which sometimes elucidate the primary evidence a great deal have not been included.7 Large chronological leaps and an idealised homogenous treatment of the medieval Western world are quite common. For example, evidence from a sermon of Pope Gregory I from around 600 is discussed side by side with a sermon written around 1220 by Jacques de Vitry (105). Later on, when the authors compare a case of isolation of a leper asylum in France, they ‘state definitively’ that in Byzantium there is no textual evidence for the intentional isolation of lepers (113), although it seems likely that the Zotikos foundation was located outside of the urban centre of Constantinople. On the other hand, the authors make a very good point in bringing to our attention the sole example of a woman in the Greek-speaking world who appears to act as a representative of the lepers on Venetian Crete in 1411, and in comparing her with two cases from fourteenth-century France where certain women seem to have had a major role in the supervision of “leprosariums” (135-8).
The study is substantiated by three appendices, which provide generally good translations of Aretaeus’ text and two early Byzantine sermons. These are extremely useful for the modern reader, although the authors do not explain in what way their translations differ from earlier ones.
There are several misspellings in references to primary sources: e.g., “arataba” for “artaba” (82), “Notkar” for “Notker” (105), “Koutoumousiou” for “Koutloumousiou” (187), “Tétrobiblon” for “Tétrabiblon” (202), and “Kletotologion” for “Kletorologion” (228). Furthermore, there are many cases of inconsistent transliteration of the long vowels and breathings in Greek publications cited in the bibliography: e.g. “euagē idrymata” on p. 230, but “euage hidrymata” on p. 232.
The book will certainly stimulate further discussion on the history of leprosy in Byzantium and the medieval West. All in all, it provides a new survey of leprosy in the medieval world, which could be of use for scholars from a variety of disciplines.
1. See, for example, S. Berger, “Comparative history,” in S. Berger et al (eds.), Writing History: Theory and Practice. London 2003, 161-79.
2. In another instance of imprecision in relation to primary evidence, the authors cite a secondary source rather than the primary source in referring to a case of leprosy described in an Egyptian magical papyrus (13). In fact, the transmission of the aforementioned papyrus text (PGM XXIIa.15) is controversial, since part of the line referring to elephantiasis is based on the editor’s conjecture in the absence of any extant parallel passages. K. Preisendanz et al (eds.), Papyri Graece Magicae. Leipzig 1974, II.147.
3. These texts are often highly rhetorical and the recurrent appearance of references to lepers does not necessarily point to a factual increase in the numbers of contemporary leprosy cases.
4. This term more properly denotes Western examples of long lists of composite drugs, but not the so-called Byzantine iatrosophia, which – apart from pharmacological recipes – also usually contain substantial sections giving details on diagnosis and prognosis, sometimes intermixed with remedies of a magical or religious nature. Furthermore, when referring to the Greek physician Archigenes, the authors invariably call him a pneumatist, although it is widely debated whether he should be considered a pneumatist, a methodist, an empiricist, or simply an eclectic. See A. Mavroudis, Ἀρχιγένης Φιλίππου Ἀπαμεύς. Ὁ Βίος καὶ τὰ Ἔργα ἑνὸς Ἕλληνα Γιατροῦ στὴν Αὐτοκρατορικὴ Ῥώμη. Athens 2000, 23-35.
5. See, for example, Parisinus gr. 2194 (s. XV), ff. 339r-340r, which contains the full text of Aetios.
6. M. McVaugh (ed.), Inventarium sive chirurgia magna. Leiden 1997, I. 282-90.
7. See, for example, J. Boldsen, “Epidemiological Approach to the Paleopathological Diagnosis of Leprosy,” American Journal of Physical Anthropology 115 (2001), 380-7.