Download PDF | Walking Corpses Leprosy In Byzantium And The Medieval West Cornell University Press ( 2014)
261 Pages
PREFACE AND ACKNOWLEDGMENTS
The title of our book, Walking Corpses, was inspired by these lines from an anonymous funeral oration, delivered in 407 in honor of the former bishop of Constantinople, John Chrysostom (see appendix 3 for the entire section of this speech dealing with leprosy). The same image of the victims of leprosy as half-dead, walking corpses appears in Gregory of Nazianzos’s powerful sermon, On the Love of the Poor, and in Gregory of Nyssa’s oration on leprosy (see appendix 2 for the full text).
From these passages one can clearly perceive that leprosy, an illness that contemporary physicians identified as Elephant Disease, terrified men and women of the early Byzantine Empire. As a result of sermons such as these, however, religious leaders in Asia Minor, Constantinople, and the other lands of the Eastern Mediterranean attempted to redirect this terror in the face of leprosy and its supposed contagiousness to support a campaign to assist the victims of Elephant Disease through a network of leprosariums, institutions that provided lepers with food, housing, palliative care, and perhaps, most importantly, with a sense of community to replace their families and their city-states (what Greeks called the “poleis”).
As we, the authors, translated these powerful sermons, we decided that the story of leprosy in the Byzantine Empire and especially the response of the medieval Greek world to the victims of this disease had not been sufficiently examined. Moreover, when we began to read the many recent books and articles on medieval leprosy and its effects on the Latin Christian world of Western Europe, we realized that no study had examined closely how Byzantine ideas about leprosy, and the leprosariums created by those ideas, had in turn shaped the attitudes and institutions of Catholic Christendom. The need for such a new approach to the study of medieval leprosy seemed even greater when we recalled that this disfiguring disease became more common in Western Europe after the First Crusade (1096-99), that is, after Western warriors had passed through the regions of the Byzantine Empire. Walking Corpses thus traces leprosy’s advance through the medieval Christian world from the Eastern capital of Constantinople and the provinces governed by this great city, first to Italy, then to France, and finally to the farthest reaches of the West and North.
As our project unfolded, we needed help from many quarters. Working at Salisbury University, a regional school on Maryland’s eastern shore, Timothy Miller would have been unable to complete his part of the project without the help of Deborah Malone and Marilyn Ruddy of the interlibrary loan office of Blackwell Library who managed to obtain copies of obscure journals and old editions of Byzantine medical texts. For example, they located for our project a collection of documents from Venetian Crete (sixteenth century), published in the journal Kretika Chronika. Perusing these documents, we found the first indication that women participated alongside men in governing leprosariums in Crete and in other leper asylums in France and Italy.
Also at Salisbury University, Nicholas Melczarek helped clarify for us some of the more abstruse points in Michel Foucault’s theory of exclusion, while Christopher Briand of the biology department checked our partial translation of Aretaios’s On Acute and Chronic Diseases (see appendix 1) to ensure that we had used the proper modern terms for genus and species in identifying plant names in the text. Many other colleagues at Salisbury University made contributions in informal conversations, often in corridors and at the lunch counters on campus.
Thelonious Williams, a history major at Salisbury University, helped us solve a number of computer issues in preparing the final manuscript copy, problems that were simple for his fellow students but seemingly insurmountable to us. Moreover, Thelonious’s interest in Richard Coeur de Leon and the ducal administration of Aquitaine motivated us to take a second look at southern France and its government one hundred years later in the late thirteenth century and at the mysterious association of leprosariums around the cities of Narbonne and Toulouse.
Alice-Mary Talbot, Director of Byzantine Studies Emeritus at Dumbarton Oaks Research Library and Collections, played a key role in our research by bringing to our attention the two poems by Manuel Philes (1275-1345) describing victims of Elephant Disease (i.e., leprosy). One of these poems provided interesting insights into the perceived connection between leprosy and lust.
We also wish to thank John Duffy, John Nesbitt’s colleague and Dumbarton Oaks professor of Byzantine philology and literature, Harvard University, for his assistance in photocopying the leprosy chapter of Book Thirteen in Aetius of Amida’s summary of ancient Greek medicine, compiled in the sixth century. It is an indication of how much work still needs to be done in the field of Byzantine medicine that no complete Greek edition of Book Thirteen of Aetius’s work exists. With Professor Duffy’s help we obtained a copy of the Latin translation of Aetius’s discussion of leprosy in a rare 1542 edition of the text.
We are especially grateful to Stamatina McGrath, adjunct professor of history at George Mason University, for her help in locating valuable sources on the care of orphans in the Byzantine Empire. Before turning our attention to lepers and leprosariums, we both studied the Great Orphanage of Constantinople, the Byzantine Empire’s premier philanthropic institution. In fact, Constantinople’s only leper asylum, the Zotikos Leprosarium, was an agency subject to the director of the orphanage. While working at Dumbarton Oaks, Stamatina found two key references to the care of orphans by provincial bishops, sources that helped connect the central orphanage of the capital to the general responsibility of Christian bishops to care for children without families, a duty that came to include the victims of leprosy. For, as we shall see, lepers suffered a fate even worse than that of orphans, since they were abandoned not only by their families but by their friends and communities as well.
We also are grateful to Peter Potter of Cornell University Press not only for finding readers who carefully reviewed our manuscript and made many valuable substantive suggestions to improve our arguments but also for his extensive efforts in helping us prepare our manuscript for publication.
Our research has shown that references to Byzantine leprosariums after 1204 are rare. Dr. Adelina Angusheva-Tihanov of the University of Manchester (UK), however, alerted us to the significance of the Life of Saint Stephen Deéani (Vita Sancti Dechani), which includes a detailed description of a fourteenth-century refuge for lepers attached to the Monastery of Deéani in Serbia.
As in the past, Father John Cotsonis, director of the Archbishop Iakovos Library at Hellenic College/Holy Cross Orthodox School of Theology, has again offered us his invaluable assistance in identifying a colorful and moving manuscript illumination for the Iveron Monastery on Mount Athos (codex 5), an illustration of Christ healing the leper in Mark’s Gospel (1:40—45). With the kind permission of Abbot Nathaniel, this illustration appears on the cover of Walking Corpses. The monks of the Holy Monastery of Vatopedi have also permitted us to use an illustration from one of their Byzantine manuscripts.
Finally, we wish to remember Father David Johnson, S. J., Professor Emeritus of Semitic and Egyptian Languages at the Catholic University of America. For thirty years Father Johnson had been a good friend and a helpful colleague while teaching Coptic language and papyrology at the Catholic University. In the summer of 2011 he was diagnosed with pancreatic cancer and died on Thanksgiving Day of that year. We recently discussed with him the possibility of finding additional information on leprosy and leprosariums in Byzantine Egypt, but he had already grown too weak to read. We thank him for the encouragement he gave us as we wrote this book.
INTRODUCTION
Leprosy occupies a special place in the history of contagious diseases. It is closely related to tuberculosis, yet people react far differently when they think of Margarite, the consumptive heroine of The Lady of the Camellias, coughing spasmodically, than they do when observing lepers bathing their oozing sores. The consumptive evokes pity, as Dumas intended in his romantic novel, but the image of lepers inspires fear and revulsion and in many a strong desire to flee from their presence. Medieval writers even described the victims of leprosy as the living dead. What image could inspire more terror?!
Leprosy triggers such reactions because its more extreme symptoms can be so terrifyingly visual. The most severe form of the disease, lepromatous leprosy, causes horrifying alterations in the body’s appearance. Persons with this form of the disease develop skin lesions and over time experience a loss of sensation, especially in the hands, feet, and face. After lesions and crusty nodules break out both on the face and body, the skin thickens and becomes rough and cracked. Ancient Greek physicians compared the effects of leprosy on human skin to the hide of elephants. Nasal mucosa thickens, commonly resulting in nosebleeds; ulceration and destruction of tissue follow. Since leprosy also attacks bone, it can alter the skull structure around the nose and mouth so that the face takes on a grotesque appearance. As the disease progresses, various nerves can incur damage, including those of the face, forearms, and the legs below the knees. Gradually, patients suffer a diminution of sensory and motor function and begin to walk with a staggering gait. In the end, they may experience a loss of their toes and fingers. Because the effects of leprosy resembled the rot of death, Byzantine preachers sometimes called its victims “walking corpses.”
For people living during the Middle Ages, conscious of the divine power in every natural manifestation, the decaying flesh of leprosy was especially disturbing. Were its victims being punished or being readied for heaven? Were they saints like Job, tested in their patience, or sinners in the hands of an angry God? Were they bearing Christ’s sufferings in their own flesh, or were they in league with the devil? In view of the disfiguring effects of the disease on the human body, it is no wonder that observers were both horrified and fascinated by leprosy. Moreover, during the twelfth century the disease suddenly flared up throughout Catholic Europe, an epidemic that seared the collective psyche of Western society with a fear of contagion. Even the young Saint Francis of Assisi was terrified of lepers.?
The medieval Catholic Church responded to the leprosy epidemic of the twelfth century by constructing charitable institutions called leprosariums throughout Western Europe. Although this philanthropic response was part of a larger effort within Christendom at the time to assist a wide range of people in need—poor travelers, orphans, pregnant, and homeless women, as well as people with curable diseases—the leprosy epidemic called for its own particular measures. In addition to providing care for those debilitated by this sickness, such leprosariums also offered lepers an alternative to living in close contact with family members and neighbors, some of whom harbored fears of catching the disease.
The fear engendered by lepers also cast its shadow over literature produced in Europe during the high and later Middle Ages. It was not uncommon for the suffering victims of this disease to appear as evil characters in chivalric romances. In several versions of Tristan and Isolde, lustful male lepers begged King Mark to let them ravish the beautiful Isolde as punishment for her unfaithfulness.* In the French romance The Quest for the Grail, a once-beautiful lady castellan, now hideously disfigured by leprosy, bled Perceval’s sister to death because she needed the blood of a pure maiden to
restore her health.*
Studying the Disease
When one considers the macabre nature of leprosy and the complex reactions it provoked in medieval society, it is easy to understand why modern scholars have been drawn to the subject. An early influential book on leprosy in the Middle Ages was Saul Brody’s The Disease of the Soul (1974).° A historian and literary critic, Brody analyzed medieval romances to illustrate how Christian Europe interpreted leprosy as a symbol of sin. Since then a wealth of scholarship has been published internationally, in both article and book form exploring nearly every facet of the disease.’ One of the more noteworthy studies appeared in 1988, Histoire des lépreux au Moyen-Age, by the French scholar Francoise Bériac. In it Bériac examined leprosy in medieval France from many angles, taking into account medical writers, popular literature and romances, pious stories and sermons, and documents (both published and unpublished) from the archives of French leprosariums.® A year later, Frangois-Olivier Touati published a detailed study of leprosy and leprosariums in one ecclesiastical province, that of Sens, from the twelfth to the fourteenth century.’ More recent scholarship has built on and extended the impressive work of Bériac and Touati. We now have access to published archives of medieval leprosariums as well as geographical surveys that map the location of leprosariums in parts of France and Germany. These, along with bioarchaeological research on skeletons from leprosarium cemeteries, are changing our understanding of both the disease itself and its treatment throughout the Middle Ages.!”
Despite this extensive body of research, popular perceptions of leprosy as a “disease of the soul” have been slow to change. Surprising though it may seem, Enlightenment hostility to medieval civilization has combined with late nineteenth-century concepts of contagious disease and quarantine measures to cast a long shadow over contemporary ideas concerning leprosy and how medieval society reacted to it.!! As Touati has demonstrated, the force of these preconceptions is so strong that even Michel Foucault, who strove to free the study of the past from conventional epistemological systems, fell victim to its distorting influence.’ In his introduction to Madness and Civilization, first published in English in 1967, Foucault referred to medieval leprosariums as “cities of the damned” multiplying “over the entire face of Europe.” Such a depiction had no basis in the historical record, but the image is so powerful that it alone might explain why old ideas about leprosy persist in the face of new research.'3 Even reputable histories of medicine such as
Roy Porter’s The Greatest Benefit to Mankind (1997) perpetuate these views.
Leprosy became highly stigmatized. Authorized by ancient Levitical decrees, leper laws were strict in medieval Europe. They were forbidden all normal social contacts and became targets of shocking rites of exclusion... . They were segregated in special houses outside towns, lazarettos, following the injunction in Leviticus that the “unclean” should dwell beyond the
camp."
One of our main reasons for writing this book, therefore, is to address these common misperceptions that continue to linger in the popular conscience as well as in some scholarly circles about leprosy in the Middle Ages. The fact is, despite the abundance of solid research in recent years, few attempts have been made, especially in English, to synthesize our understanding of this horrific disease and how medieval society responded to it. Furthermore, it also needs to be said that much of what we know about leprosy in the Middle Ages comes from scholarship focused almost exclusively on the Western half of the Christian world, leaving Byzantium out of the picture entirely. This is despite the fact that the Greek Byzantine Empire (often called the East Roman Empire) shared a common religious tradition and inherited the same Greco-Roman culture as did Western Europe.”
There are very good reasons, however, for considering the Latin West together with the Byzantine Empire when studying the history of leprosy. The earliest recorded outbreak of the disease occurred in the eastern Mediterranean during the third century BC. In the late antiquity period, the Byzantine state and church were confronting leprosy and its effects well before the Latin West. Indeed, they were forced to reckon with the disease as early as the dedication of Constantinople in 330 and up until the final conquest of the city by the Ottoman Turks in 1453. We believe it is essential, therefore, to integrate the story of leprosy in the East and the West into asingle, comprehensive account. As we will demonstrate, the ideas, attitudes, and institutions forged by the Greek Christians of the eastern Mediterranean naturally passed to the West. Here these ideas and institutions helped guide Latin Christians as they faced the same sanitary and social problems caused by leprosy in the twelfth and thirteenth centuries that Byzantine Christian leaders had confronted in the fourth and fifth centuries.'°
At the same time, it is important to recognize that there were other forces that influenced how the West confronted leprosy. Although Latin Christendom shared a common classical culture and a common Christian religion with Byzantium, the Western Empire was overrun during the fifth and sixth centuries by Germanic tribes that introduced new attitudes and institutions different from those in the Eastern Empire. Our study explores the new perspectives on leprosy and leprosariums that this Germanic influence introduced into the West.!”
Our research has arrived at a number of significant conclusions. First, contrary to the findings of some researchers, ethical writings from the Byzantine world and from Catholic Europe did not, as a rule, brand leprosy as punishment for sin; rather, theologians and moralists saw the disease as a mark of God’s favor on those chosen for heaven. Leprosy became for both Orthodox and Catholic Christians the “Holy Disease.” Second, the stimulus to ban lepers from society and ultimately to persecute them came not from Christian influence but from Germanic customary law. Finally, leprosariums, both in Western Europe and Byzantium, were not prisons to punish lepers but were centers of care to offer them support. Some leprosariums even provided residents the opportunity to govern their own communities under a form of written constitution.
Unlike other charitable facilities such as general hospitals or orphanages, the residents of leprosariums regularly met to make decisions about their institutions’ finances and regulations. In some leprosariums residents were even allowed to impeach a prior or master for dishonesty or incompetence. More surprisingly, female lepers sometimes participated alongside their male counterparts in community meetings and assisted in managing the leper asylums. Women were even chosen to act as representatives of these institutions, and in several documented cases women served as priors of their leprosariums with authority over male residents and staff members. Ultimately, our study confirms that the general picture emerging in recent scholarship was that leprosariums, far from being prisons to punish lepers or isolate them totally from the society of the healthy, provided a protected environment. In some of these institutions, male and female lepers were able to participate in what was, in fact, an experiment in democracy under a form of constitutional government.
In support of our discussion of leprosy and leprosariums in the Byzantine Empire, we include English translations of three key texts in Greek. One of these—a section of an anonymous funeral oration in honor of John Chrysostom—has never been translated into English and has only been available in a printed Greek text since 2007. The section of Aretaios of Cappadocia’s medical compendium describing leprosy was last translated into English
in 1857.
What Is Leprosy?
Galen of Pergamon, born in Western Asia Minor in 130 AD, became the most renowned physician of the Greco-Roman world. He enriched the medical observations attributed to the fifth-century (BC) Hippocrates with his own anatomical research and personal experiences with patients. Galen also integrated the findings of earlier Hellenistic scientists into his many studies to produce a masterly corpus of medical wisdom. Any modern physician or biologist who holds ancient Greek medicine in contempt as a collection of unfounded theories and folk remedies should read Galen’s remarkably detailed and accurate description of the muscles, bones, nerves, and tendons in the human hand.!®
Galen’s writings not only won him the respect of his contemporaries, including the emperor Marcus Aurelius, but also the homage of succeeding generations. He came to dominate subsequent Greek medicine so that doctors throughout the thousand years of Byzantium rarely questioned his opinions, and in the Arabic world physicians revered him as one of the founders of medical science. Influenced by the treatises of Islamic medicine, Western physicians also considered Galen an infallible expert on the human body and its illnesses. To medieval health professionals around the shores of the Mediterranean, Galen’s medical works spoke with an authority almost equal to that of the Bible or the Qur’an.
Galen, like other ancient writers, referred to leprosy as “elephantiasis,” or “Elephant Disease.” If we were to ask Galen what caused the disease, he would have responded clearly and with great confidence that it arose from an excess of black bile in the body. Galen made just such a reply to his friend, the philosopher Glaucon.!” Black bile, or melancholia, was one of the four humors—blood, phlegm, yellow bile, and black bile. According to the dominant Greek medical theory, which Galen forcefully supported in his treatises, men and women remained healthy when their bodies maintained the correct balance of these humors. An excess or a dearth of any one of these fluids resulted in illness. If, for instance, the body had too much black bile and did not manage to eliminate the surfeit, leprosy was the most serious of several possible effects from such an imbalance.
Although by the sixteenth century European physicians and scientists had begun to challenge how Galen described the human body and its illnesses, no one succeeded in replacing his explanation for leprosy until 1873, when the Norwegian scientist Gerhard Armauer Hansen identified Mycobacterium leprae as the bacteriological agent that caused leprosy. Hansen had been conducting research on leprosy because the number of cases of the illness had been increasing in Scandinavia during the nineteenth century. Hansen was convinced that Mycobacterium leprae could easily spread from one victim to another, thus he recommended that victims voluntarily avoid contact with others—a recommendation that subsequently helped reduce the number of people with leprosy in Norway within a few years of Hansen’s discovery. As a result of Hansen’s achievement, modern science has renamed leprosy “Hansen’s disease.””°
Modern science has also identified two different manifestations of Hansen’s disease: lepromatous leprosy and tuberculoid leprosy. There exists only one strain of Mycobacterium leprae, but the human body responds to the bacterium in several different ways. In fact, most people have a natural immunity to leprosy. This explains why the disease has never affected more than 10 percent of a population at any particular time and place and has not had the devastating demographic effects of bubonic plague and smallpox. This also accounts for the fact that not all ancient or medieval observers of leprosy were convinced that the disease was highly contagious.
Among people susceptible to the disease, some have limited resistance and develop tuberculoid leprosy, which causes skin lesions, swellings, and even some nerve damage and which, in turn, can lead to the loss of fingers and toes. If the body has no ability to resist the bacterium, the patient eventually comes down with the dreaded lepromatous form of Hansen’s disease, which if left untreated produces the horrifying effects on the human body described earlier.7!
Modern experts on infectious diseases have identified the bacterium that causes leprosy; they can also explain the different manifestations of the illness. More important, since the early 1980s modern medical therapies can stop the spread of Mycobacterium leprae in the victim’s body, although they cannot repair any damage already done to tissues, nerves, and bone. Despite these advances in knowledge, medical science has not been able to solve the riddle of leprosy epidemics—why the disease remains in a population, at first attacking only a few victims, but then suddenly becomes aggressive and infects many more people. The epidemic of the European High Middle Ages, therefore, is still a mystery, as is the apparent epidemic that struck the Eastern provinces of the Roman Empire in the fourth century AD.
Although Hansen and his contemporaries were convinced that the disease caused by Mycobacterium leprae was the same illness that people in medieval Europe called “leprosy” and Galen and later Byzantine physicians named “Elephant Disease,” modern scholars are not so sure—for several reasons. First, many skin infections have symptoms that can easily be confused with Hansen’s disease. Second, Mycobacterium leprae, like other bacteria, may have changed its structure over the centuries while, at the same time, humans were likely developing new defenses against this pathogen. Both of these mutations surely affected the observed symptoms.” Third, the ancient and medieval sources employ a confusing bundle of names for the disease. When leprosy first appeared in the Mediterranean, Greek physicians called it kakochymia and, later, leontiasis and satyriasis, before settling on the name elephantiasis, or Elephant Disease.
Modern studies have shown that Hansen’s disease, in its lepromatous form, not only attacks tissue but corrodes the bone around the oral and nasal cavities and leaves distinctive marks on toe and finger bones. It is possible, therefore, to examine skeletal remains and positively identify individuals who died with an advanced stage of Hansen’s disease.” Indeed, paleopathologists have studied forty skeletons from a leper cemetery at Aachen, 358 skeletons from a Danish institution, and smaller numbers from leprosariums in England. Between 70 and 80 percent of these skeletons display clear signs of Hansen’s disease.”* However, the leprosarium cemeteries excavated so far represent a very small percentage of the total number of such burial sites.
Until we have a far greater body of supporting skeletal evidence, therefore, it is wise not to assume that all incidents of Elephant Disease were in fact Hansen’s disease. With this in mind, throughout the book we will only use the term Hansen’s disease in its modern, scientific context. When discussing the disease in its premodern context, we will use leprosy, Elephant Disease, and elephantiasis, which more closely represent the terms contemporaries would have used to identify what they were witnessing. It is important to note, however, that modern physicians use elephantiasis to identify an entirely different disease. For more on the evolution of the usage of this term, see pages 17-22.
Our study tracing the movement of Elephant Disease from the Eastern Mediterranean basin to Western Europe compares the reactions of people from different places and centuries to what they believed was the same incurable disease of leprosy. By juxtaposing institutions and ideas from the Greek-speaking world of Byzantium with those of the Latin and Germanic world in the West, remarkable similarities become visible. Some of these similarities resulted from reactions to the same threat to public health; others resulted from deliberate imitation. Although there are risks in a study that spans so many years and casts it gaze over such a wide expanse of territory, this wide perspective provides significant new insights into the history of leprosy in Europe and the institutions designed to assist its victims.
To understand leprosy and its impact on medieval society, first it is necessary to go back in time to the initial major outbreak of the disease in the ancient Mediterranean. We will review the earliest Latin, Greek, and Hebrew words used to identify this strange new scourge. We will consider Jewish reaction to leprosy and how this response shaped early Christian attitudes toward this illness. From there, we will turn to the first incidents of the disease in the Byzantine world.
Link
Press Here
0 التعليقات :
إرسال تعليق