Shropshire Routes to Roots

2. Leprosy

Few diseases have created such fear nor engendered such cruel reactions to their victims as leprosy. Today we think of this infectious disease as being largely a disease of the past, or limited to tropical areas of the world. This was not always the case. In Britain, leprosy was a relatively common affliction in the early medieval period. Today approximately 13 million people are still affected by the disease although it is treat-able. Indeed in many parts of the world peoples reaction to leprosy is not dissimilar to our medieval ancestors.

What evidence is there for the presence of leprosy in Shropshire?

St Giles Church, Shrewsbury Larger image, in a new window [18kb] [Reproduced with kind permission of Secret Shropshire]

In Shrewsbury during the medieval period there were three hospitals. St Giles, the patron saint of cripples, is a common dedication to a leprous institution. The church, pictured here, was founded in 1136 and was attached to the nearby leper's hospital which was located 2 miles from the town centre on the road to Wenlock. This was believed to be sufficiently far out of the town for the risk of infection to be reduced. The church was rebuilt in the 1860's but still stands on the site of the original chapel. The first record for the hospital was in 1155 when Henry II pronounced that not only were the lepers of Shrewsbury able to beg for alms, but they were to be given a double handful of corn and one of flour from every sack sold in Shrewsbury Market. A hundred years later St Giles was also granted a horse load of firewood every day from the Kingswood at Condover.

Bridgnorth had four hospitals in the early medieval period of which two were for lepers, St. James and the Vetus Maladeria. Early records show that the Leper Hospital, which had stood on the site of a house known as St James priory seen here, was situated between the Kidderminster and Stourbridge Roads. On the edge of Morfe Forest.

In 1244 the King granted the inmates the right to gather a horse load of dead wood daily from the forest. The site and land are thought to have been given by King Henry I after an appeal by the Pope. The Hospital admitted both sexes and was staffed by Monks who cared for the sick as well as lepers. The other lazar house was to the west of the town towards Oldbury.

St James' Priory, Bridgnorth Larger image, in a new window [31kb] [Reproduced with kind permission of Secret Shropshire]

Lazar houses were also built at St Giles's Ludford, near Ludlow on the Herefordshire side of the river. At Aston near Oswestry and possibly at Much Wenlock.

What causes leprosy?

Leprosy is an infectious disease. The organism responsible for the infection is Mycobacterium leprae which is transmitted by droplet infection. It primarily affects the nervous system but can also involve the skin and blood vessels causing horrible mutilations. The changes in the individual vary greatly depending on the general health and resistance to infection (immune status) of the victim. Ill health, poor nutrition and even pregnancy may have worsened the effect of the disease. The more severe and disfiguring class of the disease was most probably that seen in medieval Europe.

How does leprosy affect the sufferer?

Leprosy requires a combination of circumstances for it to flourish.
The disease starts by attacking the nerves causing a lack of sensation or anaesthesia. Secondary infection then occurs resulting from accidental injury.
The tissues of the face, nose and eyes are affected. The face becomes blotchy and the bridge of the nose collapses. The nose has a persistent discharge and there is bacterial invasion of the throat. Leprosy is visible in the archaeological record as the changes affect the skeleton.

Leprous changes to the skull Larger image, in a new window [16kb] [Reproduced with kind permission of Frances Lee]

Changes to the face are associated with the most infective form of the disease. The nose gradually becomes depressed and there is infection to the nasal cavity and palate. The skull opposite has no nasal spine and the margins of the nasal cavity are rounded both the result of leprous infection.

The less infective form of the disease affects the nervous system resulting in loss of feeling, to the limb extremities. The mutilating features which we associate with lepers are caused by minor and repeated injury to the insensitive foot and to a lesser extent the hands. Fingers and toes gradually become contorted, due to a poor blood supply, and ulcers form on the sole of the foot. The foot on the left is normal while on the right the toes have been lost there are also ulcerated changes in the mid foot.

The leprous foot Larger image, in a new window [19kb] [Reproduced with kind permission of Frances Lee]

What did people believe caused leprosy in the Middle Ages?

The Christian view of leprosy changed over time. Originally it was seen as the result of deep seated moral decay or wickedness. The leper was struck by this affliction to pay for his sin. Later with the church's view on purgatory the leper was seen as one of God's elect. An individual allowed to endure purgatory on earth and so pass directly to heaven. This lead to a benefactor endowing leper institutions with the aim of shortening their alloted time in purgatory.

How successfully were lepers segregated in Medieval society?

The segregation of lepers had a minimal effect on the spread of the disease as the incubation period for leprosy is between 2-7 years before the symptoms become visible. During this time the sufferer would have been highly infectious.
Lepers were required to live apart from the rest of the community by a decree made by Pope Alexander III in 1179. Few could afford to live an isolated life at home so they entered a hospital. Here they were offered a sufficient diet, clean and warm surroundings.
Leper Institutions tended to be sited just outside the town walls. Alms gathering was an important source of the hospital's income and so main roads and junctions became favoured sites. Land would also have been cheaper providing greater opportunity for self sufficiency with the hospital owning gardens and orchards. Leprosy hospitals were certainly not isolation hospitals. Many elderly and infirm individuals sought admission, while lepers who misbehaved could be expelled!

Why was leprosy only a problem in Britain during the medieval period?

The Norman Crusaders are thought to have brought back the disease from the continent. This would account for the growth in the foundation of Leprosaria from the 11th century onwards so that by the 13th century there were over 200 leper hospitals in existence in Britain. The decline in the disease began in the 14th century, so that by the time of Henry VIII no-one could recall why the Shrewsbury leper hospital had been founded. The reasons for the decline are not fully understood. Segregation clearly did little to halt the spread of the disease. The Black Death may have accelerated the decline in the disease, not only were lepers susceptible because their immune system was compromised, but by reducing the total population the potential for leprosy to spread would have been reduced.
Interestingly the decline in leprosy also coincides with a marked increase in Tuberculosis. Both these diseases are caused by similar Mycobacteria and there is a growing body of evidence to suggest that the two diseases are to some extent interlinked. Indeed it seems to be that an increased exposure to Tuberculosis might confer some form of immunity to leprosy. The disease declined steadily so that by the 18th and 19th centuries there were only a few cases reported in Scottish Islands.

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