Walking Corpses

Leprosy in Byzantium and the Medieval West

Timothy S. Miller, John W. Nesbitt

• Publisher: Cornell University Press
• Year: 2014
• eBook ISBN: 9780801470769
• Topic: Geschichte
• Subtopic: Europäische Geschichte des Mittelalters

Leprosy has afflicted humans for thousands of years. It wasn't until the twelfth century, however, that the dreaded disease entered the collective psyche of Western society, thanks to a frightening epidemic that ravaged Catholic Europe. The Church responded by constructing charitable institutions called leprosariums to treat the rapidly expanding number of victims. As important as these events were, Timothy Miller and John Nesbitt remind us that the history of leprosy in the West is incomplete without also considering the Byzantine Empire, which confronted leprosy and its effects well before the Latin West. In Walking Corpses, they offer the first account of medieval leprosy that integrates the history of East and West.In their informative and engaging account, Miller and Nesbitt challenge a number of misperceptions and myths about medieval attitudes toward leprosy (known today as Hansen's disease). They argue that ethical writings from the Byzantine world and from Catholic Europe never branded leprosy as punishment for sin; rather, theologians and moralists saw the disease as a mark of God's favor on those chosen for heaven. The stimulus to ban lepers from society and ultimately to persecute them came not from Christian influence but from Germanic customary law. Leprosariums were not prisons to punish lepers but were centers of care to offer them support; some even provided both male and female residents the opportunity to govern their own communities under a form of written constitution. Informed by recent bioarchaeological research that has vastly expanded knowledge of the disease and its treatment by medieval society, Walking Corpses also includes three key Greek texts regarding leprosy (one of which has never been translated into English before).

Chapter 1

THE ANCIENT WORLD

At some date in the early decades of the third century BC, Greek physicians at Alexandria were beginning to see cases of the malady they called “Elephant Disease.” After Alexander the Great’s conquests, this city had become the heart of Greek intellectual life and a major center for medical science. It is likely that these physicians had identified the most serious form of the disease, lepromatous leprosy. If they had also encountered instances of tuberculoid leprosy, they probably did not call it “Elephant Disease” because its symptoms were much less dramatic than lepromatous leprosy, and it was more likely to have been diagnosed as any number of other skin diseases (as sometimes happens even today).

Many scholars believe that Elephant Disease entered Egypt from India, its appearance along the Nile being the unintended result of settling Macedonian soldiers in Egypt who had fought in India under Alexander the Great. This is a reasonable hypothesis because Indian literary sources have clearly shown that Elephant Disease was well established in South Asia before Alexander’s invasion, and thus those Macedonian soldiers susceptible to its pathogen could have easily contracted the disease while fighting there.¹

It is also possible that the spread of the illness received a renewed impetus under King Ptolemy II Philadelphus (283–46 BC) when Greek merchants engaged in trading ventures between Egypt and India by way of the Red Sea. Living in close contact with the Indian population, these traders could also have contracted leprosy and served as vectors when they returned to sell their merchandise in various Egyptian entrepôts.²

Modern scientific research has confirmed that leprosy had reached Egypt by the time of the Ptolemaic kings (after 305 BC). Paleopathologists examined skeletons, discovered in the Dakhleh Oasis, and have confirmed that four of these show the effects of lepromatous Hansen’s disease. These skeletons belonged to Europeans, either Greeks or Macedonians, not to native Egyptians, and they were dated to the second century BC. The results of this bioarchaeological research prove that Mycobacterium leprae had arrived in the Mediterranean basin sometime after Alexander’s Eastern conquests.³

Ancient Physicians and Elephant Disease

The scientific evidence provided by these skeletal studies thus confirms the statement found in a medical treatise by the Greek physician Rufus of Ephesus. Writing in the first century AD, Rufus observed that Elephant Disease had reached the Mediterranean basin in the decades after Alexander’s conquests. The first physician to mention what Rufus himself called “elephantiasis” was Straton, a student of Erasistratus, the famous physician and anatomist who had practiced medicine and conducted dissections of the human body under King Ptolemy I (305–281). Straton had identified the disease as kakochymia (literally, a bad mixture), a name referring to the unbalanced mixture of humors.⁴

According to Rufus, subsequent medical experts abandoned Straton’s terminology. Some physicians began to describe the first stages of Elephant Disease as leontiasis because the patient’s face took on the appearance of a lion, with sagging cheeks and eyebrows and with thickening lips. The patient also began to give off a bad odor, like a lion. Other doctors identified the second stage of the disease as satyriasis because the patient’s cheeks reddened, the eyebrows became puffy, and the victim was seized by a desire for sexual gratification, like a satyr. In its more advanced stage the illness produced black protuberances on the legs, face, and body. Some of these tubercles developed oozing ulcers. In severe cases, the fingers and toes fell off. According to Rufus, physicians called this final stage of the disease “elephantiasis.”⁵

In his poem “On the Nature of Things,” the Roman philosopher Lucretius (first century BC) had expressly stated that Elephant Disease originated in Egypt: “The sickness is called the elephant which arose along the canals of the Nile and nowhere else.”⁶ In the Apotelesmatika, a work ascribed to the Egyptian writer Manetho of the third century BC but written much later during the Roman Principate, the unknown author observed that those who suffered from elephantiasis came to have “the skin of elephants of measureless age.”⁷

Echoing the statement of Lucretius, Pliny the Elder (23–79 AD) stated that elephantiasis “is native to Egypt.” He observed that the disease initially manifested itself on the patient’s face, but this stage was followed by an outbreak of scabrous encrustations of diverse sizes and colors on various parts of the body. In time the sores turned black, and the toes began to swell. Pliny alluded to the spread of elephantiasis in Italy, but he maintained that the contagion had been unknown there before the time of Pompey the Great (died 48 BC). Pliny added that the disease did not remain a problem for long in Italy and vanished from the peninsula.⁸

Writing a few decades later, in the Greek peninsula, Plutarch (ca. 46–120 AD) also took up the question of the chronology of Elephant Disease in a passage of his Table Talk, which was devoted to the possibility that new diseases suddenly appeared. During an animated after-dinner discussion, a Greek physician named Philo averred that knowledge of elephantiasis was relatively recent because no physician of ancient times had mentioned it. Since Philo was a resident of Hyampolis in Phocis, a town in central Greece, we may conclude that his comments referred to his native city and that he believed that elephantiasis had arrived there only recently. Plutarch countered Philo’s statement about Elephant Disease by noting that in a work by a philosopher named Athenodorus, the author had stated that the illness had first been noted in the time of the Bithynian physician Asclepiades, a doctor who had practiced medicine in Rome in the first century BC.⁹ Plutarch’s observation on elephantiasis thus confirms Pliny’s statement that the disease arrived in Rome during the life of Pompey.

In the second century AD the renowned Galen of Pergamon identified Alexandria as the place where Elephant Disease was widespread. Galen observed that large numbers of Alexandrians suffered from Elephant Disease because of their diet and the hot climate. He described the Alexandrian diet as consisting of gruel and lentils, snails, brine-preserved foods, and donkey meat, all foods that generated black bile. The effect of this diet, according to Galen, was to produce, in conjunction with the heat of the region, a thick, melancholic humor that entered the blood and eventually rose toward the skin.¹⁰

Galen recommended bloodletting as a treatment for Elephant Disease, followed by the administration of purgatives, both procedures designed to eliminate the excessive quantity of black bile in the body. As for topical salves, Galen recommended an ointment made from berry juice, but because it tended to be greasy, he suggested as substitutes a salve prepared with zinc oxide and another salve made from calcite.

With regard to diet, Galen favored hefty draughts of a liquid made from peeled barley or of whey from milk. Patients were encouraged to eat vegetables such as orache (a leafy plant) and round gourds when in season, as well as fish and fowl. Galen especially recommended, however, the consumption of viper meat. The great physician was in essence recommending a kind of sympathetic magic; just as the skin of vipers sloughed off, so too would the scales and tubercles of leprosy fall away if one consumed the snake meat.

Galen included detailed instructions on how to prepare the viper delicacy. First, the head and tail of the snake had to be removed along with all the inner organs and the skin. The flesh was then washed in water and prepared by boiling the meat until soft in a mixture of water, olive oil, leeks, and dill. Galen also advised that patients drink a potion of snake meat boiled with salt and a little dill. This same mixture could be applied directly to sores.¹¹

We encounter a cure of a different sort in an Egyptian papyrus document of the second century AD. In this case we are dealing with what is undeniably magic, not medical science. The text suggested that a patient with leprosy carry a verse from the Iliad written “on a clean sheet of paper” and “tied with the hair of a mule.” The verse had to be Iliad 4.141: “as when some woman colors ivory with purple dye.” Why the papyrus text specified this verse is unclear, but it probably refers to how Elephant Disease gave the skin of its victims a dark hue.¹²

Aretaios

Aretaios of Cappadocia, according to some experts a contemporary of Galen’s, wrote the most complete description of Elephant Disease by an ancient Greek or Roman physician. In his treatise called On Acute and Chronic Diseases, Aretaios included two separate sections on leprosy: one to describe the disease and another to suggest treatments.¹³

Aretaios himself has baffled modern historians of medicine for many reasons.¹⁴ First, he wrote in an archaic Ionic Greek in imitation of Hippocrates. We have no other examples of such an effort. Second, his text shows clearly that he had conducted postmortem autopsies to identify lesions and other effects of specific diseases on the body’s internal organs. We have no other examples of such pathological anatomical studies until Christian times, when physicians in Constantinople cut open the buboes of plague victims during the reign of Justinian (541–42).¹⁵ Third, Aretaios mentioned no other physicians in his text, references that might have provided some clue as to when Aretaios lived. Finally, no other physician referred to Aretaios before the reign of the emperor Constantine.

Historians of medicine have been arguing for more than one hundred years about when Aretaios wrote. Some have suggested that he lived as late as the fourth century; others have maintained that he was active before Galen’s birth (130 AD) because Aretaios espoused a strong pneumatist physiology. In other words, he believed in the primacy of pneuma—a life-giving substance present throughout the universe. Its proper movement and mixture inside the human body guaranteed health. Aretaios’s physiology closely paralleled that of the pneumatist Archigenes who had written medical texts during the reign of Trajan (98–117). Because physicians after Galen appear to have abandoned pneumatist ideas, medical historians have hesitated to assign Aretaios to the third or fourth centuries.¹⁶

Aretaios opened his study on leprosy symptoms with a detailed description of an elephant—its color, size, and body structure, as well as its eating and drinking habits. He digressed on the subject of elephants to show why Greek physicians often called leprosy the “Elephant” or “elephantiasis.” According to Aretaios, physicians used these terms because leprosy gave the patient a black hue like an elephant and because it was the strongest of diseases (i.e., incurable) just as the elephant was the strongest among the beasts. Aretaios’s elephant section, however, is so long (more than a third of the whole section on leprosy symptoms) and so detailed that he surely had some other purpose in mind.¹⁷

Greek physicians such as Rufus of Ephesus recognized that Elephant Disease had arrived in the Mediterranean region during Hellenistic times. This had led some ancient medical writers to speculate that new diseases arose from “seeds” that were released at a precise point in time into the human environment from under the earth or perhaps from other worlds. As we saw earlier, Plutarch recorded a debate among learned colleagues concerning the origins of new diseases such as Elephant Disease, a debate that took place circa 100 AD. Influenced by the ideas of the philosopher Democritus, Philon, the physician from Hyampolis, proposed the idea that new diseases originated because of corpuscles that had entered our world from outside it. Plutarch, however, dismissed this theory as a form of mythologizing and argued instead for the traditional Hippocratic concept of disease as an imbalance caused by bad diet and immoderate lifestyles. Plutarch suggested that under the peaceful Roman Empire it had become possible to import exotic foods from faraway regions. These foods, combined with new habits of life, might easily produce novel imbalances that in turn generated previously unrecorded diseases. One did not need to invent alien creatures inhabiting other worlds to find a rational origin for Elephant Disease.¹⁸

Let us return to Aretaios’s description of the elephant. Is it possible that Aretaios introduced the essay on elephants and their peculiar way of life to suggest that leprosy resembled an elephant in that it too was an exotic species, an entity in itself that existed apart from the imbalance it caused in any particular human body? Besides the curious metaphor of the elephant, Aretaios hinted at the possibility of disease seeds when he discussed how leprosy was transmitted from person to person.

Aretaios emphasized that Elephant Disease was contagious. It passed from victim to victim just as rapidly as did a disease called loimos. Thucydides had used this term to describe the highly contagious illness that struck Athens in the early years of the Peloponnesian War.¹⁹ Aretaios explained that people were afraid to live with lepers because “a rapid infection occurs through exhalation to spread the disease...

Table of contents

• List of Illustrations
• Preface and Acknowledgments
• Introduction
• 1. The Ancient World
• 2. Leprosy in the Byzantine Empire
• 3. Byzantine Medicine
• 4. Byzantine Leprosariums
• 5. Leprosy in the Latin West
• 6. Leprosariums in the Latin West
• 7. The Knights of Lazarus
• Conclusion
• Appendixes
• List of Abbreviations
• Notes
• Bibliography