A nation-wide support system for lepers in 14th century France

Introduction

It is generally accepted that the earliest possible account describing a skin condition resembling leprosy, the tumour of the God Xensu, is found in the Ebers Papyrus dated to about 1550 BCE.¹ However, the earliest absolute archaeological evidence of leprosy in Egypt is described in an Egyptian skeleton from the second century BCE. In contrast, archaeological evidence of leprosy from India dates to about 2000 BCE.² There is also a possible reference to the disease prior to the first millennium BCE in the Atharva Veda Sanskrit hymns.³ On the basis of nucleotide polymorphisms of rare contemporary samples, it has been suggested that leprosy evolved first in Asia and subsequently transmitted to Europe, West Africa and later the Americas.⁴ In Europe, the first accurate description of the disease, referred to as elephas, was written by Arataeus of Cappadocia around 150 ACE.⁵

Despite the empire expansion designs of Alexander the Great and later the Roman Empire, it appears that leprosy remained a relatively rare disease in Europe during the Classical Age. Its prevalence appears however to have increased in Medieval Europe with the east-west migration and trade exchanges that occurred during the first millennium ACE.⁶ The increasing prevalence of the disease led to the enactment of legislation by secular authorities to arrest its diffusion emphasizing segregation of the infected from the health community in accordance to Biblical direction (Leviticus 13:45). This gave rise to the establishment of lazar-houses or leprosaria throughout Europe and the Middle East. The absolute segregation imposed by secular authorities caused ecclesiastical authorities to attempt establish means of addressing the rights of the segregated infected to religious practice. These rights, defined by the Council of Lateran in 1179, established that ‘where a number of leprous people are gathered together in community they shall be permitted to enjoy to themselves a church, churchyard, and priest of their own. But they must take care that this be no ways injurious or pre-judicial to the rights of parish-churches’.⁷ A lazar-house established in Jerusalem in the fourth century ACE was to gain European prominence after the First Crusade of 1099. This establishment known as hospitali infirmorum sancti Lazari de Jerusalem was to expand its sphere of influence throughout Europe and establish daughter houses in France (established 1154), England(1157), Hungary(1162), the Holy Roman Empire(1184), Kingdom of Two Sicilies(1226), and Kingdom of Castile.(1248) ⁸

Lazar-house management

Shunned from the healthy community, leprous individuals formed permanent communities based on a monastic pattern supported by benefices and donations given by a wide range of benefactors. According to the Canon-Penitentiary of Saint-Victor at Paris Robert de Flamborough writing in 1208-1215, lepers living in leprosaria were to be considered religious communities since they lived according to a set of regula based on Christian principles similar to the monks and canons, the Templars and Hospitaller Orders, and the religious brothers or sisters who cared for the sick in general hospitals or hospices.⁹ The first known regula regulating life in French leprosaria were those promulgated by Raymond Bishop of Montpellier in 1149-1158 (p.181-183).¹⁰ In 1226, King Louis VIII of France further promulgated a code of laws to regulate the lazar-houses in his dominium.¹¹ Guy de Foulques, Bishop of Le Puy eventually elected Pope Clement IV, in 1256-1259 also drafted a very detailed set of leprosarium regulations written with the aim of guaranteeing the rights of the lepers in residence ensuring their self-government but ensuring segregation from the healthy members of the community to avoid spread of infection. These were very much in line with the edicts laid down by the Council of Lateran in 1179 (p.206-214).¹⁰ Other surviving regulations pertaining to French leprosaria date to the late twelfth to fourteenth centuries (p.181-252).¹⁰ These regulations suggest that these regional establishments functioned in isolation of one another being frequently managed by preceptors chosen by and from within the leper community. They were financially supported by the municipal secular or ecclesiastical authorities. While generally following similar precepts, the regula determining management within these regional establishments were distinct and separate from each other.

In contrast, the European-based establishments managed by the fratres Sancti Lazari extra muros Jerusalem leprosis were interlinked and regulated by a common regula primarily based on the Rule of Saint Augustin. The earliest extant compilation of these regula available was written during 1314-1321 by the preceptor of the house at Seedorf in Switzerland.¹² According to this regula, the leprous sick on admission to the establishment took the three monastic vows of chastity, poverty and obedience. They thus became full brothers who slept in a dedicated dormitory separate from the healthy brothers who formally joined the establishment to assist the sick. The healthy and sick members were expected to participate in all the liturgical activities of the monastery keeping the canonical hours of matins to compline. The organization of the fratres Sancti Lazari was thus comparable to that of a traditional monastic community following the Rule of St. Augustine with all the establishments following the same rule and subservient to the mother house sited respectively in Jerusalem, Acre and Boigny, France.¹³ Management in the mother house was originally left to a leprous master, but after 1253 pontifical permission was obtained from Innocent IV to appoint a non-leprous master.¹⁴

In 1265 with the Bull Venerabilibus fratribus, Clement IV confirmed the privileges of the fratres Sancti Lazari and placed all leper-houses in the West under their protection and government.¹⁵ In the Kingdom of Sicily and Naples, Charles I of Anjou in 1268-1271 ordered that all the leprosaria in his domains were to be placed under the protection and government of the fratres Sancti Lazari. This arrangement was maintained after the War of the Sicilian Vespers resulted in the division of the Kingdom of Two Sicilies by letters patent from Robert of Anjou, King of Naples dated the 29 April 1315 who gave similar instructions within his realm.¹⁶ However, it is not clear how many, if any, of the French establishments were managerially taken over by the fratres Sancti Lazari. France had a significant number of lazar houses said in 1226 to number not less than 2000 in total. The number of establishments continued to increase so that there was scarcely a town or burgh in the country that was not provided with a leprosarium.¹⁷ While supported by religious and philanthropic benefices which provided care and shelter to the victims of leprosy, the leprous marginalized community was generally looked upon with suspicion and disdain by the healthy population supported by the belief that the disease symbolized sin or punishment for sin. This suspicion, coupled with the fear of a Muslim advance to France from the Iberian Peninsula, led to a paranoid fear that led to the Lepers’ Plot hysteria of 1321 when it was alleged that lepers had, in cohesion with the Muslim Emir of Granada and the Jewish community, organized themselves to poison the wells throughout Europe in an attempt to either kill the healthy community or to transmit leprosy. The hysteria may well have been further fuelled by a desire of the monarchy and municipal authorities to appropriate the benefices of the various leprosaria and belongings of the Jewish community.

The 1321 Lepers’ Plot

The Lepers’ Plot flourished in the wake of the 1320 Shepherds' Crusade, which saw rural mobs attack Jews in France and the neighbouring Kingdom of Aragon, despite being ordered to stop by Pope John XXII, King Philip V of France and King James II of Aragon. In France, the Bishop of Bazas Raymond-Bernard de La Mote reported that some of the apprehended mobsters of the Shepherds’ Crusade had claimed to have found barrels filled with rotten bread while pillaging the leprosarium (possibly near Le Mas-d'Agenais) and further alleging that the lepers had intended to use the bread to prepare poisons for contaminating well water. Following these allegations, the mob’s attention turned towards the lepers. Leprosaria were attacked and torched. The municipal authorities, on their part, undertook measures to attempt to appropriate the benefices accruing to the leprosaria in their region and thus attempted to “protect” the properties. In July 1320, the lieutenant of the porévot of Sauveterre-de-Guyenne forbade the torching of the leprosarium in the town.

News of the so-called Lepers’ Plot spread rapidly to Aragon. King James of Aragon initially reacted by ordering the arrest and expulsion of all leprous foreigners. On 27 June, James ordered the arrest of lepers, destruction of their powders, and questioning under torture. He further ordered the arrest and expulsion of non-leprous foreigners, ‘since it is difficult, truly even impossible, to recognize such and identify them’. Local inquisitions were set up. Those who confessed were burnt.¹⁸

In December 1320, the Bishop of Dax had all lepers in his diocese arrested, an act that may have helped precipitate the subsequent violence and contribute to the charges brought against the lepers in the spring of 1321. By February 1321, the communities of Toulouse, Albi and Carcassonne had petitioned the French monarchy to segregate the lepers and expel the Jews from France. The consuls further attempted to gain jurisdiction over the autonomous properties belonging to the leprosaria offering their services to administer the revenues and pious donation accruing to the lepers and provide for the leper’s maintenance. These petitions were not favourably received by the king and the petitioners took matters into their hands. The Mayor of Pérginueux ordered lepers to be arrested and tortured by judicial officers. Many who confessed under torture were burned at the stake. These arrests by the municipal authorities were considered a clear usurpation of royal prerogatives.¹⁸

While the actions against lepers and leprosaria were being taken by the various municipal authorities, King Philippe V was in Poitiers presiding over an assembly of the towns in the south of France. On the 21 June 1321, he issued an order declaring that this plot of poisoning the water supplies by the lepers constituted an attack on the king’s majesty and therefore subject to the authority of the king’s courts. In this way, all the seized leper belongings reverted to the Crown. Lepers who confessed their involvement in the plot were to be burned at the stake; those found innocent or who were aged under fourteen years were to be imprisoned in the leprosaria. On the 16 August, the king relinquished the seizure of the French leprosaria and a few days later pardoned all lepers who had been arrested and found guilty during the turmoil – in essence accepting these to be innocent and the Lepers’ Plot to have been a hoax.^19,20 Many municipal secular and ecclesiastical authorities, including Albi, Narbonne, Carcassonne and Toulouse, contested the royal claims to ownership of the seized lepers’ property forcing the king to release these to rival claimants.²¹ Individuals accused of perpetuating the Lepers’ Plot were brought before the Inquisitional Tribunal presided by Bishop Fournier (later elected Pope Benedict XII) at Palmiers in southern France.

Inquisitional testimonies

There is no definite mention of the fratres Sancti Lazari in any of the surviving testimonies. However, the testimony given by Guillaume Agasse to the inquisitional court presided by Bishop Fournier suggests the involvement of a nationwide coherent group of interrelated leprosaria falling under one central organization that adhered to a specific chain of command structure involving superiors, commanders and preceptors – a structure very similar to that extant within the fratres Sancti Lazari in the 14^th century.²² In contrast, the twelfth to thirteenth century regulations drawn up for French leprosaria associated with municipal or ecclesiastical authorities suggest that these establishments were generally localised affairs that functioned independently from each other. They were managed by an internal management structure responsible only to the relevant municipal or ecclesiastical authority.

The case in question involved the leper Guillaume Agasse who served as a ‘clerc lépreux commandeur de la léproserie de Lestang’. Agasse was brought before the inquisitional court on the 4June 1321 in Palmiers. He was charged with allegedly having been involved in the plot to poison the wells throughout France with a mixture that would either kill the healthy communities or infect them with leprosy.²³ A similar charge was brought earlier in May 1321 against the leper Johan de Bosco from Alterque who was arrested in Regale Ville. De Bosco had testified on oath, that he had been approached by brother Geraldus, the leper preceptor of the leprosarium of Alterque, and given two bags of pessimam powder to use for poisoning the water supplies of various villages. He was paid twenty sous for his involvement and given a further ten sous to cover expenses. He believed that the mixture he was given would cause anyone who drank it to become leprous or die within two months.¹⁸

The proceedings against Agasse lasted about a month with the sentence being delivered on the 5 July 1322. Torture was resorted to by the prosecutor during the first testimony but the subsequent two depositions were made without resorting to torture. Agasse testified that, in the previous year, he had been delivered a missive from the ‘précepteur de la léproserie de la porte Arnaud-Bernard de Toulouse’ summoning him to immediately proceed to Toulouse ‘pour traiter et decider de choses qui tourneraient á mon avantage et honneur’. On his way to Toulouse, Agasse learned that Raimond, ‘minister de la maison de Saverdun’, had also received a similar missive from the preceptor of the Toulouse leprosarium. They made their way to Toulouse together and on the 11 May 1320, attended a meeting of about forty to fifty lepers, many of whom were ‘ministers et précepteurs’ from various regions of southern France, including ‘Raimond minister de la léproserie de Saverdun, Pierre de Mazéres minister de la léproserie dudit lieu, et le minister des leproseries d’Unzent et des Pujols’. Agasse could not confirm the attendance of ‘les ministers des leproseries de Foix, de Varilhes et autres lieux du comet de Foix’.

This meeting was addressed by the preceptor of the Toulouse leprosarium with the following statement: ‘Vous autres voyez et entendez comme les chrétiens en bonne santé nous tiennent, nous autres maladies, en opprobre et en abjection, qu’ils nous rejettent de leir compagnie et frequentation, et qu’ols nous tiennent en derision, blaspheme, et mépris. C’est pour cela qu’il a été discuté, délibéré et ordonné par nos supérieurs que par tout le monde oú régnent les chrétiens, soient donnés et administers par les maladies aux chrétiens en bonne santé des poisons, des charmes et des philtres, par le moyen desquels ils meurent tous ou deviennent lépreux ou maldes. Et alors, les maladies et les ministers actuals auront l’administration et le pouvoir qu’ils détiennent, recevront leurs terres et les gouverneront, et même se les approprieront. Et pour obtenir et atteindre ce but, il a été délibéré et décidé entre les supérieurs de prendre le roi de Grenade comme allié et défenseur. Ce roi a déjà annoncé à quelques-uns de nos supérieurs qu’il était dispose à nous fournir sur ce point conseil, aide et assistance. Pour realiser et mener à bonne fin la chose, il a été décidé qu’en tout lieu de toute la chrétienté les maladies mettraient, dans les sources, les puits et les eaux courantes, des poudres, des charmes ou des philtres, don’t ces eaux seraient infectées et corrompues, de telle sorte que ceux qui en boiraient deviendraient lépreux ou mourraient à bref délai. Et pour ce faire, ont été faites sur le conseil de médecins beaucoup de poudres, don’t chaque personne ici présente recevra dans des sacs de cuir ou d’étoffe, et emportera avec elle pour les metre dans les eaux, chacune dans le lieu où elle habite’. The testimony further revealed that ‘Les commandeurs supérieurs ont envoyé, pour traiter cela avec le roi [de Granda] et le Soudan [de Babylone], le commandeur de la léproserie de Bordeaux, et c’est li qui nous a rapporté cela de leur part’. The Muslim potentiates had required the lepers to renounce Christ and to spit on the cross as a sign of their commitment.²³ Towards the end of his deposition, Agasse retracted the evidence he had given against the lepers Guillaume Normand and Fertand Espanol, and against Raimond de Saverdun (who has already been executed) and Pierre de Mazéres. He assumed full responsibility and stated that he had for three months believed that the Christian faith was of no value. The involvement of Muslim support for the leper conspiracy was false – there was no Sultan of Baghdad at the time. He was found guilty only on the charge of heresy and blasphemy and condemned to perpetual imprisonment. He was not found guilty of poisoning the water supply.^24,25

The testimony by Agasse therefore confirms the existence of a nationwide French organization involving leprosaria. The management of this organization involved a chain of command linking a number of subsidiary village-based leprosaria managed by commandeurs and ministers to a larger regional one in Toulouse managed by a précepteur who in turn was responsible to a central government of supérieurs. These occasionally were summoned to meet and discuss important national issues.

The events leading to the 1320 Lepers’ Plot and the apparent attack on the benefices and leprosaria managed by the fratres Sancti Lazari who had in previous decades enjoyed Royal patronage in France need to be placed into the historical perspective. The end of the thirteenth century saw the fratres Sancti Lazari who had assumed a military role in the Outremer, loose their raison d'être with the expulsion of the Christian forces from the Kingdom of Jerusalem following the fall of Acre in April 1291. The loss of the Outremer was partly blamed on the escalating rivalry that existed between the Militant Orders particularly the Hospitallers and the Templars. The events of the subsequent two decades were to determine the fate of the various Orders expelled from the Kingdom of Jerusalem. The Hospitaller Order of St. John remained centred in the Outremer initially in Cyprus but eventually in 1310 occupied Rhodes thus acquiring their own sovereign temporal domain ensuring their survival as an organization.²⁶ On the other hand, the Knights Templar Order maintained its status as a “state within a state” with a standing European-based army that had no allegiance to any monarchy. In 1305, criminal charges were brought against the Order by an ousted Templar accusing its members of heresy. In October 1307, Philip IV of France ordered the simultaneous arrest of the Templar grandmaster Jacques de Molay and the French Templar knights. Under torture, the accused confessed to the charges brought against them. This led to Pope Clement V to issue the bull Pastoralis Praeeminentiae dated 22 November 1307, which instructed all Christian monarchs in Europe to arrest all Templars and seize all the assets of the Order. In 1308, Clement V absolved the Templars of all heresies and in a letter addressed to Philip IV wrote that all Templars that had confessed to heresy were "restored to the Sacraments and to the unity of the Church". At the Council of Vienne in 1312, Clement issued the bull including Vox in excelso which officially dissolved the Order citing the reason for the disbandment as being the public scandal that had been generated by the confessions. An additional bull Ad providam handed over all Templar assets to the Hospitallers. Freed from torture, the grandmaster de Molay and the Preceptor of Normandy Geoffroi de Charney retracted their confession and insisted on their innocence. Declared relapsed heretics, they were sentenced to burn alive at the stake in Paris on the 18 March 1314.²⁷

These events throughout Europe, but particularly in France, were to have a significant effect on the general outlook towards the fratres Sancti Lazari with their central house stationed at Boigny in France. Royal letters patents confirming the protection and support of Philippe le Bel had been given to the fratres in July 1308 (p.xvii-xviii).²⁸In spite of the Royal protection, attempts had been made by local and ecclesiastical bodies in France to appropriate the land holdings of the fratres or introduce taxation on previously exempted holdings. For example, the provost of Caen demanded taxes on the property belonging to the fratres within his region ignoring the tax exemptions previously given by Philippe Augustus II in 1200 and confirmed by Philippe le Bel in 1304. Legal proceedings were initiated with a decision that favoured the fratres in 1313. A similar attempt was made by the officers of the crown to appropriate the fratres’ property at Boigny. This too was contested in court with a favourable decision being given to the fratres in 1317 (p.154-156).²⁸ This action led to a reconfirmation in 1317 by Philippe V of the fratres’ ownership of Château de Boigny (p.xix-xx); ²⁸ while John XXII promulgated a pontifical decree in 1318 granting the fratres exemption from local ecclesiastical authority and making the fratres Sancti Lazari dependent only to the Holy See (p.159-160 ftnote b).²⁸ The environment was therefore ripe for a suspicious mob to be directed by the municipal authorities to attack the leprosaria managed by the fratres Sancti Lazari and thus appropriate the management of the associated benefices. In 1358, Regent Charles dauphin de France through Royal Letters Patent again ordered the judicial officers in the realm to protect the Order from violence and oppression, and to allow them peaceful enjoyment of their possessions and privileges (p.172-173).²⁸

The support of the various rulers to the individual regional houses was insufficient in creating a common targeted raison d'être for the fratres Sancti Lazari especially with the fall in the prevalence of leprosy in Europe following the Black Death epidemics and the effect these had on the socio-economic conditions in late fourteenth century Europe.⁶ This in effect changed the fratres Sancti Lazari into a land-owning establishment using the resources to maintain itself and give solstice to those in need. This change in ethos failed to provide the driving force necessary to maintain the cohesion of the international organization and regional houses often functioned in isolation from the central mother house in Boigny, France. The breakdown in administrative cohesion appears to have occurred in the mid-fourteenth century. In 1370, in a petition addressed to the Holy See, the master general in the central house at Boigny Jacobi de Besnes was lamenting that over the previous twenty years, no oblations had been received from some of the houses in England, Apulia, Hungary, and France. The same brothers had failed to attend the Chapter General meetings of the Order; while some had actually reverted to a secular life. In response, Pope Urbane V sent a missive to the Bishop of Paris requiring him to ensure that the absent brothers regulated their obligations under the threat of ecclesiastical censure.²⁹ While administrative cohesion was eventually achieved in France, Hungary and the Holy Roman Empire; the fratres Sancti Lazari in England, the Kingdom of Two Sicilies, and Kingdom of Castile continued to follow separate management directions.

In the Maltese Islands, no documentary evidence exists for the presence of a leprosarium in the fourteenth century. However, it has been suggested that the Medieval hospitalis Sancti Franciscj, situated outside the Medieval walls of Mdina [modern-day National Archives] may have been originally established as a leprosarium.³⁰ The establishment was definitely extant in 1372 but probably had been established in earlier decades possibly after 1299 following the appointment by Pope Boniface VIII of Cardinal Bishop Gerardus of Sabina as Apostolic Delegate to the Kingdom of Sicily with powers to grant indulgences to the faithful who assist in the running of hospitals.³¹ The first documented case of leprosy termed erga corpore morbo lepre is said to have affected a Gozitan woman Garita Xejbais who bequeathed land to the Church in 1492.³² By the end of the 15^th century, the available documentation relating to hospitalis Sancti Franciscj makes no mention of lepers but refers only to “poveri abitanti”.³³This is not surprising since the documented decrease in the European prevalence of leprosy caused by the 14^th century Black Plague epidemic had resulted in ‘closure’ of many of the previously extant leprosaria. The Maltese Islands had also been ravaged by the plague pandemic in 1363.³⁴

In Rhodes, the Order of Saint John had regulated stringent public health laws to limit the spread of the disease in the Domini Sanatatis promulgated during the reign of Grandmaster Emery D’Amboise (1530-1512). The “sick of Saint Lazarus” were beneficiaries of special charities from the Order and cared for in their homes. These regulations debarred infected individuals from having any social intercourse with healthy ones who in turn were prohibited under penalty of a hefty fine from receiving any goods from lepers. Furthermore, lepers were precluded from practicing certain occupations unless licensed by the sanitary authorities who ensured that material goods belonging to lepers were not physically passed on to healthy people. It was however not deemed necessary to segregate the victims of this infection in dedicated leprosaria. The Domini Sanatatis regulations were introduced in Malta after 1532.³⁵

In the Maltese Islands, therefore, there is no definite documented evidence of the existence of organized leprosaria during the Medieval Period. Victims of Hansen’s disease were allowed to live in the community with only a minimal degree of restrictions to their movements. They were not enforceably segregated. Segregation of these individuals was only introduced in 1893 when the Council of Government issued the Lepers Ordinance No. VII entitled ‘An Ordinance for checking the spread of the disease commonly known as Leprosy’ setting up the St Bartholomew Leprosarium to house the infected cases. The last leprosarium, at Hal Ferha estate, closed down its services in 2001.³⁶

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36. Buttigieg GG, Savona-Ventura C, Micallef Stafrace K. History of leprosy in Malta. MMJ, 2008, 20(4):34-8.

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