Images of Leprosy: Disease, Religion, and Politics in European Art 1935503146, 9781935503149

Table of contents :
Series page
Book title
Copyright
Contents
Illustrations
Acknowledgments
Introduction
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Conclusions
Appendix A
Appendix B
Endnotes
Bibliography
About the Author
Index

Citation preview

Images of Leprosy

Habent sua fata libelli Early Modern Studies Series General Editor Michael Wolfe St. John’s University Editorial Board of Early Modern Studies Elaine Beilin

Helen Nader

Framingham State College

University of Arizona

Christopher Celenza

Charles G. Nauert

Johns Hopkins University

University of Missouri, Emeritus

Barbara B. Diefendorf

Max Reinhart

Boston University Paula Findlen

University of Georgia Sheryl E. Reiss

Stanford University

University of Southern California

Scott H. Hendrix

Robert V. Schnucker

Princeton Theological Seminary

Truman State University, Emeritus

Jane Campbell Hutchison

Nicholas Terpstra

University of Wisconsin–Madison

University of Toronto

Mary B. McKinley University of Virginia Raymond A. Mentzer University of Iowa

Margo Todd University of Pennsylvania James Tracy University of Minnesota

Merry Wiesner-Hanks University of Wisconsin–Milwaukee

IMAGES OF

Leprosy Disease, Religion, and Politics in European Art

CHRISTINE M. BOECKL

Early Modern Studies 7 Truman State University Press

Copyright © 2011 Truman State University Press, Kirksville, Missouri USA All rights reserved tsup.truman.edu Cover: St. Elizabeth Bathes a Leprous Patient, 1470–77, painted panel. Detail of main altar, St. Elizabeth Cathedral, Košice, Slovakia. (Image courtesy of St. Elizabeth Cathedral,

Košice, Slovakia)

Cover design: Teresa Wheeler

Library of Congress Cataloging-in-Publication Data Boeckl, Christine M., 1933Images of leprosy : disease, religion, and politics in European art / Christine M. Boeckl. p. cm. — (Early modern studies series ; v. 7) Includes bibliographical references and index. ISBN 978-1-935503-14-9 (cloth : alk. paper) — ISBN 978-1-935503-15-6 (pbk. : alk. paper) 1. Leprosy in art. 2. Art, European—Themes, motives. I. Title. II. Title: Disease, religion, and politics in European art. N8219.L35B64 2011 704.9'49616998—dc22 2011003348 No part of this work may be reproduced or transmitted in any format by any means without written permission from the publisher. The paper in this publication meets or exceeds the minimum requirements of the American National Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI Z39.48–1992.

Contents Illustrations

vii

Acknowledgments xi Introduction An Ancient Disease in European Images

1

Chapter 1

Leprosy Worldwide and the State of Modern Research

8

Chapter 2

Historiography of Hansen’s Disease in Europe

24

Chapter 3

Societal Responses to Leprosy in Europe

45

Chapter 4

Development of the Leprosy Iconography

67

Chapter 5

Christ Healing a Leper in Christological Cycles: The Political Significance of Imperial and Royal Commissions, ca. 800–1200

92

Chapter 6

Patron Saints of Leprosy and Their Images in Religious and Political Contexts, ca. 1200–1800

107

Chapter 7

Diversity in Leprosy Subjects: Biblical Themes and Increasing Secularization, ca. 1450–1750

131

Conclusions Images of Leprosy as a European Cultural Phenomenon 162 Appendix A Sources Related to Leprosy Images

167

Appendix B The Most Prominent Saints Associated with Leprosy

191

Endnotes

195

Bibliography

215

About the Author

223

Index

225

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Illustrations Fig. 1.1

Patient with Lepromatous Leprosy, 1931.

11

Fig. 1.2

Same Patient with Lepromatous Leprosy, 1933.

11

Fig. 1.3

Leprosy Case Observed on Street.

13

Fig. 1.4

Patient with Late Neural [Borderline?] Leprosy.

14

Fig. 1.5

Reconstructive Surgeon Examines Young Patient with Flexion Deformity of Hand; comparison with a detail from a fifteenthcentury painting (fig. 3.4).

16

Fig. 1.6

Trained Technician with The Leprosy Mission Instructs Patient in Care of Artificial Limb.

17

Fig. 1.7

Map of Norway, Average Incidence Rates of Leprosy by County (1851–1920).

21

Fig. 2.1

ἀ e Suffering Job and His Wife, detail of Sarcophagus of Junius Bassus.

25

Fig. 2.2

Annual Leprosy Inspection, 1493, woodcut from broadsheet. 27

Fig. 2.3

Cover of Codex Aureus, ca. 870, gold relief.

31

Fig. 2.4

Christ Healing a Leper, detail from cover of Codex Aureus, ca. 870, gold relief (fig. 2.3).

32

Fig. 2.5

Leper’s Head, detail of Christ Healing a Leper from cover of Codex Aureus (fig. 2.4).

33

Fig. 2.6

Christ Healing a Leper, from Gospel Book of Otto III, ca. 1000, book illumination.

34

Fig. 2.7

Christ Healing a Leper, comparison of details from fig. 2.6.

36

Fig. 2.8

Lazarus and Dives, detail of cloister column, Abbey of Cadouin, France.

40

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Images of Leprosy

Head of Lazarus, detail from Lazarus and Dives (fig. 2.8); comparison with Patient with Lepromatous Leprosy.

42

Fig. 2.10

Hans Holbein the Younger, Head of a Young Man, 1523, drawing.

43

Fig. 3.1

Aureliano Milani, St. Aloysius of Gonzaga (?) Administering the Viaticum to a Plague Victim, first quarter 18th century, oil on canvas.

54

Fig. 2.9

Fig. 3.2

William of Tyre Discovers Baldwin IV’s First Symptoms of Leprosy, 14th century, book illumination. 56

Fig. 3.3

Inspection of Leprous Patients, woodcut in Hans von Gersdorff, Feldbuch der Wundartznei (Strasbourg: Johannes Schott, 1517), p. 67.

58

St. Elizabeth Bathes a Leprous Patient, 1470–77, detail of main altar, St. Elizabeth Cathedral, Košice, Slovakia.

61

Fig. 3.4

Fig. 3.5

Gentile da Fabriano, ἀ e Crippled and the Sick Cured at the Tomb of St. Nicholas, 1425, painted panel. 63

Fig. 4.1

Josaphat Meets a Leper and a Cripple at the Gate of Jerusalem, detail from Vincent Beauvais, Miroir Historial, fol. 373, book illumination.

70

Cornelis Engebrechtsz, Naaman’s Cure in the Jordan, detail of Naaman Triptych, ca. 1524, painted panel.

74

Fig. 4.3

Christ Healing a Leper, detail from Andrews Diptych, 9th century?, ivory relief.

76

Fig. 4.4

Detail from Christ Healing Ten Lepers, 12th century, mosaic, Cathedral of Monreale, Sicily.

77

Fig. 4.5

Detail from Emperor Constantine Struck with Leprosy, ca. 1240, fresco, Capella di San Silvestro, Santi Quattro Coronati, Rome.

81

Fig. 4.2

Acknowledgments Illustrations

 ix

Detail from Pope Sylvester Baptizes Emperor Constantine, ca. 1240, fresco, Capella di San Silvestro, Santi Quattro Coronati, Rome.

82

Fig. 4.7

St. Martin and a Leprous Beggar, detail from Cšeriny Altar, painted panel.

84

Fig. 4.8

Israel van Meckenem, St. Elizabeth with a Leprous Beggar (Die Heilige Elisabeth), 1475–80, engraving.

86

Fig. 4.9

St. Elzéar of Sabran Ministering to Leprosy Patients, ca. 1373, marble carving.

88

Fig.5.1

Detail from Christ Healing a Leper, 12th century, mosaic, Cathedral of Monreale, Sicily.

103

Fig. 6.1

Detail from Emperor Constantine Struck with Leprosy, ca. 1240, fresco, Capella di San Silvestro, Santi Quattro Coronati, Rome.

112

Detail from Constantine Oἀers the Tiara to Sylvester, ca. 1246, fresco, Capella di San Silvestro, Santi Quattro Coronati, Rome.

114

Detail of Officium Stratoris, ca. 1246, fresco, Capella di San Silvestro, Santi Quattro Coronati, Rome.

115

Prefect Tarquinius Interrogating St. Sylvester, 1322, fresco. Detail of Legend of Sylvester, Constantine, and Helena, fresco, Hohe Domkirche St. Peter und Maria, Cologne.

118

Fig. 6.5

St. Peregrinus, the Leprous Pilgrim, 1350–51, book illumination.

121

Fig. 6.6

St. Elizabeth Placing a Leper in Her Husband’s Bed, detail of Holy Kinship Altar, 1516?, painted panel, Smrecany Church, Slovakia.

125

St. Elizabeth’s Eviction from Wartburg (left) and St. Elizabeth Bathes a Leprous Patient (right), details of Holy Kinship Altar, 1516?, painted panel, Smrecany Church, Slovakia.

126

Fig. 4.6

Fig. 6.2

Fig. 6.3

Fig. 6.4

Fig. 6.7

x 

Images of Leprosy

Hans Holbein the Elder, St. Elizabeth with ἀ ree Male Petitioners, 1516, painted panel, right wing, Sebastian’s Altar.

127

Cosimo Rosselli, Christ Healing a Leper, detail of ἀ e Sermon on the Mount, 1481, fresco, Sistine Chapel, Vatican Palace.

133

Fig. 7.2

Christ Healing a Leper, a comparison of details from figs. 2.6 and 7.1.

135

Fig. 7.3

Cornelis Engebrechtsz, Naaman Triptych, ca. 1524, painted panel.

137

Fig. 7.4

Cornelis Engebrechtsz, SS. Cosmos and Damian, 1524, detail of Naaman Triptych (fig. 7.3).

138

Fig. 7.5

Cornelis Engebrechtsz, Soldier[?]: ἀ e Leprous Naaman, 1524, detail of Naaman Triptych (fig. 7.3). 141

Fig. 7.6

Cornelis Engebrechtsz, Soldier[?]: ἀ e Leprous Gehazi, 1524, detail of Naaman Triptych (fig. 7.3).

142

Fig. 7.7

Hieronymus Bosch, St. Bavo Giving Alms to the Poor and Sick, ca. 1504–08, right outer wing of the Altar of the Last Judgment, painted panel.

146

Fig. 7.8

Comparison of figures 1.3 and 7.7.

149

Fig. 7.9

Rembrandt, Man in Oriental Costume or King Uzziah Stricken with Leprosy[?], ca. 1639, oil on panel.

152

Fig. 7.10

Jacques de Gheyn II, Dan, ca. 1589, engraving.

154

Fig. 7.11

Claes Jansz Visscher (author), Procession of Lepers on Copper Monday, 1608, etching.

159

Fig. 6.8

Fig. 7.1

Acknowledgments The ancient scourge known the world over as Hansen’s disease, or clinical leprosy, has recently been the subject of numerous outstanding publications. This volume provides the latest and most comprehensive overview in the field from the art historical perspective. Approximately ten years ago, the topic was suggested to me by medical historian Luke Demaitre (University of Virginia), whose most recent book, Leprosy in Premodern Medicine: A Malady of the Whole Body (Johns Hopkins University Press, 2007), was essential for the conception of this study. I am sincerely grateful for his endorsement of my project. I thank Daniel H. Connor, M.D. (Georgetown University), for his help with the clinical and bacteriological aspects of Hansen’s disease and the use of his photographs, which are invaluable contributions to this study. I acknowledge my indebtedness to John E. Bennett, M.D. (National Institute of Health) for introducing me to the latest editions of his key publication in infectious diseases, even before the volumes arrived at the libraries. The international experts Mark Spigelman, M.D., and Helen D. Donoghue, M.D. (UCL Medical School, Center for Infectious Disease and International Health), graciously provided information on crucial DNA data to complete the history of the disease. Additionally, I received important information from the European leprosy research facilities in Bergen, Münster, and Budapest, and I owe a debt of gratitude to Lorentz Irgens, Ph.D., M.D. (National Leprosy Register of Norway), and Eva Tank-Nielsen. Director Ralph Klötzer (Gesellschaft für Leprakunde, Münster) and Director Maria Vida (Semmelweiss Museum, Budapest) also contributed to this book. While visiting Budapest, I was very kindly received by the staff of this exceptional medical museum. Particular thanks go to historian Livia Kölnei, whom I must credit with supplying me with historical data and introducing me to the wealth of images still in situ in Eastern European churches. Thanks are also due to Jo Robertson, research officer at Oxford University (ILA Global Project on the History of Leprosy). I was fortunate to be able to work with Documentary Photographer Patricia Gallinek, R.N., xi

xii 

Images of Leprosy

who recorded leprosy missions globally; I received her permission to publish images depicting modern facilities and treatment options. To my friends and colleagues at UMD, I am deeply indebted for their encouragement and input to my research, first and foremost Susan Jenson, who helped shape this book by extensive discussions of the material and her kind editorial assistance. With gratitude I also acknowledge the quintessential technical support of Elisabeth Hartjens (Imagefinders) in preparing illustrations for printing as well as the scholarly assistance of Elisabeth and her sister, Maria Wieken-Mayser, and of Konrad Groß (Erzbischöfliche Diözesan- und Dombibliothek Köln mit Bibliothek St. Albertus Magnus). Moreover I owe a debt of gratitude to Eva and Nicholas H. Allen (University of Maryland, University College) and Edith Wyss in getting my challenging project started. I also appreciated the help extended by Shirley Bennett, Diana Whithee, Marguerite Tassi, Elizabeth Ettinghausen, Bertha L. Gutmann, and Sally Wages. Special thanks are due to my revered former professor Jean Caswell for her continued interest in my work! I want to mention gratefully several individual scholars and international institutions. In my hometown, Gerhard Schmidt (University of Vienna), Renate Trnek (Akademie der bildenden Künste), Gudrun Swoboda (Kunsthistorisches Museum), and Irmgard Hutter (independent scholar in Byzantine studies); at Munich’s Alte Pinakothek, Martin Schawe (Curator of Early German and Netherlandish paintings); at Washington, DC’s National Gallery of Art, Arthur K. Wheelock Jr. (Curator for Dutch Art), Margaret Morgan Grasselli (Curator of Old Master drawings), and Andrea Gibbs (Image Collection); Gudrun Bühl, Gerrianne Schaad, and Natalie Tetriatnikov at Dumbarton Oaks; and C. Griffith Mann at The Walters Museum of Art, Baltimore. At the National Library of Medicine, National Institutes for Health, Stephen Greenberg with his profound knowledge of rare books and images in the collection, kind and resourceful Crystal Smith (reference librarian), and historian Michael Sappol all have been of great help. Indispensable for my research were Paul Williamson (Curator at the Victoria and Albert Museum, London) and Joe Plommer (Academic Image Rights Assistant, Victoria and Albert Museum, London) who searched beyond the call of duty all possible sources to provide me with the correct highintensity images. He also facilitated the process of getting the required

Acknowledgments

 xiii

permission papers ready on time. Similarly when time was of essence, I received assistance from Diane P. Naylor (Chatsworth’s photo librarian). Special thanks are due to historians Raymond and Elizabeth Mentzer (University of Iowa) for their extensive input and their support of my project from its inception. I acknowledge the beneficial advice of several theologians who generously donated their time and shared their expertise: Fr. Martinus Cawley, Shawn Madison Krahmer (St. Joseph’s University), and Stephen Vicchio (College of Notre Dame of Maryland). Richly illustrated art history publications are a special challenge to any press. I am extremely grateful to Nancy Rediger, Director/Editor-inChief at Truman State University Press, along with her excellent staff. I want especially to thank Teresa Wheeler, designer not only of this book’s striking cover but of the cover for Images of Plague and Pestilence. The excellent work produced by copy editor Barbara Smith-Mandell cannot be expressed in words; production editor Judy Sharp is largely responsible for great legibility of the fifty-some illustrations in this book; and last but certainly not least, I thank Michael Wolfe, General Editor for the Early Modern Studies series. Most of all, I thank my dear friend, Dee Fischer, for her dedicated efforts in preparing my book manuscripts for publication! I also thank Frances Kianka for scholarly advice, editorial skills, and support when under time pressure. Further, I thank my former graduate student Lucia Plachy for her efforts in executing my extensive correspondence in Slavic languages. Finally, I want to mention José Giròn (Bank of America) for solving at a critical moment my wire-transfer problems to Eastern Europe. There cannot be any doubt that the manuscript has improved as the result of the anonymous readers’ astute observations and thoughtprovoking questions; I am sincerely beholden to them. I am deeply grateful to my children and their families for their loving support and especially for their assistance with computer technology, without which my efforts would never have gone to print.

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Introduction

An Ancient Disease in European Images

“Leprosy remains unique in the annals of human disease, in its epidemiological pattern, and in the social and religious reactions which it engendered,” wrote Keith Manchester in his seminal article, “Leprosy: The Origin and Development of the Disease in Antiquity.”1 Because leprosy is still a global concern at the beginning of the twenty-first century, the disease recently generated a great deal of attention in a number of scholarly fields, from medical science to literary reviews. This volume analyzes select artworks spanning over a millennium that portray persons suffering from leprosy. The topos lepra and its visualization in murals, stained glass, book illuminations, sculpture, and other media probably first appears in the fourth century ce. Subjects depicted in these images are based on scripture and hagiographic accounts; secular topics are rare. This inquiry highlights the significance of leprosy themes in mainstream Western art—incidentally, the only culture to develop that topic. Byzantine visual conventions, although illustrating the same biblical scenes, never investigated clinical manifestations of the illness. Although this volume is an interdisciplinary art historical handbook covering art, history, medicine, and religion, it uses terminology customary to the field of art history, since images are the primary documents and art history provides the fundamental debate. Discussion of style is restricted to comments on the realism of clinical leprosy markers. Comparisons of historic sculptures and paintings with clinical photographs, a methodology I developed in Images of Plague and Pestilence: Iconography and Iconology, present the reader with a tool to gauge the medical knowledge of the artist, physician, and/or patron, by investigating the manifestations of Hansen’s disease in medieval and early modern representations. This exploration pursues several objectives—all essential for a novel art historical analysis. First and most significantly, it discusses the status of modern medicine and reviews how knowledge of leprosy was gained over the last two thousand years and how it affected the visual arts. Recent DNA research opened a new approach 1

2 

Images of Leprosy

to the long-debated topic: is the biblical lepra the same sickness as clinical leprosy (i.e., Hansen’s disease)? Analyses of scenes depicting Christ healing a leper, included in chapter 2, provide evidence that Western art illustrated the symptoms of the stricken in such a way that one can identify the manifestations as clinical leprosy. Chapter 4 also presents original research that describes the developments in leprosy iconography (description of the image). The four introductory chapters address clinical leprosy worldwide, the European history of the disease, societal responses, and the development of leprosy iconography. Because of the diversity of the subject matter, these chapters use a topical approach and may be read independently; they also serve as useful reference material anticipating some of the questions readers may have regarding later discussions in the text. Innovative blending of multidisciplinary issues introduces and frames chapters 5 through 7, the three chapters of iconological interpretations (meaning of the images). The last and most crucial segment of the book targets the main argument concerning iconological explorations regarding how the ancient scourge became an emblematic vehicle to recount and express the inherent symbolic meaning of the images. This section opens the proverbial window to the past that allows us to search for answers to the following questions: Who commissioned the works? What were the patrons’ motivations? What was the religious significance of the art? When, where, and, above all, why was a subject with little popular appeal depicted repeatedly? Finally, the book will consider the status of the victims: What attitudes were held by society toward the sick in general and the disenfranchised, leprosy-infected patients in particular, and how did history visually record these persons? This part of the discussion is presented chronologically, focusing on the evolution—how the subjects developed over time. I maintain that the various terrifying aspects of the disease become the overarching concept that unifies the discussion by introducing narratives about the lives of historic and legendary figures stricken with the dreaded illness. Rulers, beggars, saints, and sinners, the metaphor of leprosy supplies the background against which the enlightening stories are projected. Because the literature on leprosy is vast, a cursory annotated presentation of the most important sources, organized by the various disciplines, is included in the introduction.2

Introduction

 3

Chapter 1 includes information on current attempts to treat leprosy victims with multidrug treatments on an outpatient basis; this part was written under the expert guidance of Daniel H. Connor, M.D. To gain a historical view on contagion and on epidemiology, treatises available to medical practitioners at various periods regarding diagnoses, treatment, and prevention of the illness are cited. Luke Demaitre’s brilliant archival study of original medical manuscripts, Leprosy in Premodern Medicine, mentioned in the acknowledgments, is compulsory reading; it is one of the most important works in that field. For medical questions concerning the leprosy discussions of chapters 1 and 2, several books are essential. Chapman H. Binford and Daniel H. Connor’s Pathology of Tropical and Extraordinary Disease: An Atlas is a groundbreaking publication that includes the seminal observations of Binford’s pioneering experiences at the time when effective drug therapy was not yet available. His co-editor, D. H. Connor, published his own field experiences more recently in Pathology of Infectious Disease. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, now in its 7th edition, is a key work. Other important medical handbooks I consulted included W. H. Jopling’s Handbook of Leprosy. The innovative and unique research project of Lorentz Irgens, M.D., Ph.D., Leprosy in Norway: An Epidemiological Study Based on a National Patient Registry, aided me in determining previously ignored environmental aspects of Hansen’s disease and how these could have been related to earlier events. Of utmost significance are the findings of the international team of DNA experts (C. D. Matheson et al.) published in 2009, which provides the first scientific evidence that leprosy was present in ancient Palestine at least since around the birth of Christ. In 1974, Samuel Brody was the first author to undertake a truly interdisciplinary approach to leprosy in ἀ e Disease of the Soul: Leprosy in Medieval Literature.3 Katharine Park, Charlotte Roberts, and, above all, Keith Manchester produced numerous excellent, and more recent, publications on the divergent aspects of leprosy. For a brief review of the cultural history of the disease, see Sheldon Watts’s Epidemics and History: Disease, Power and Imperialism. Carole Rawcliffe’s Leprosy in Medieval England is an indispensable resource, with its wealth of information on pre-Reformation English art and its comprehensive discussions of leprosy legends and imagery. Marcia Kupfer’s ἀ e Art of Healing: Paintings for the Sick and the Sinner in a Medieval Town is considered a

4 

Images of Leprosy

benchmark in Romanesque scholarship. Several innovative publications by David Marcombe also contributed to the content of chapter 3. Iconography provides the foundation for this art historical analysis of leprosy, but this volume also contains an important compilation of textual sources that influenced, over a thousand-year period, the Europeans’ perception of leprosy; these are listed in the appendix. The analysis of leprosy themes begins with the Old Testament, which is remarkable in the often-contradictory connotations associated with sara’at/lepra that provide vital information regarding how religion evaluated leprosy patients. Even though Latin Western art rarely illustrated these subjects, Kurt Weitzmann’s and John Lowden’s profound publications on a series of Greek Octateuchs are essential for our understanding of Old Testament traditions. New Testament scenes, on the other hand, primarily stressed Christ’s compassion in healing the suffering. Miracle cures make up the majority of leprosy subjects in Christian art and must have been illustrated in countless illuminated Bibles (not all of them survived, or have been studied) between the ninth and the nineteenth centuries. The Index of Christian Art (formerly The Princeton Index: Art before 1400), a thematic register combined with photographic illustrations, provides by far the most effective place to start research on this extensive topic. Although it is difficult to quantify leprosy images, the Index’s organization by subject matter, location, media, and dates is useful in gaining insight, for instance, into the number of extant manuscripts in a specific region. Moreover, numerous standard lexica assist with subject matter and lists of illustrations. Gertrud Schiller’s Iconography of Christian Art and E. Mâle’s Religious Art in France, the Late Middle Ages: A Study of Medieval Iconography and Its Sources present the best overviews. However, the discussion on “Aussatz und Aussätzige” in H. Aurenhammer’s Lexikon der christlichen Ikonographie provides the most thorough treatment of the subject. Louis Réau’s Iconographie de l’art chrétien, though somewhat outdated, is still a valuable research tool. Lepra in de Nederlanden (12de–18de eeuw) and K. Grön’s richly illustrated article “Leprosy in Literature and Art” both introduce pertinent material. The same is true of W. B. Ober, M.D.’s “Can the Leper Change His Spots? The Iconography of Leprosy.” Collectively these publications have approximately one hundred historical images illustrating patients of leprosy; many of the articles are written quite recently. Finally, Andor Pigler’s

Introduction

 5

Barockthemen is interesting primarily for the dearth of leprosy imagery, since the topic was rarely pursued after the Renaissance period. On iconological interpretations, see Erwin Panofsky’s Studies in Iconology: Humanistic ἀ emes in the Art of the Renaissance. Christ healing a leper is the most popular of all leprosy themes, revealing the Christocentric tendencies of the Carolingian, Ottonian, and Norman rulers. E. Kantorowicz’s ἀ e King’s Two Bodies: A Study in Medieval Political ἀ eology; James Snyder’s Medieval Art; Percy Schramm’s Kaiser, Rom und renovatio; and Janet L. Nelson’s fascinating Charles the Bald provide insight into the political background of that era. The sixth chapter, focusing on patron saints of leprosy, deals explicitly with political theology (a theological concept dominated by political, social, economic, and cultural concerns). Numerous murals portray St. Sylvester baptizing and thus curing the “leprous” Emperor Constantine, a narrative based in part on the spurious ninth-century Donation of Constantine, which guaranteed great privileges to the heirs of St. Peter’s throne. For the historic background of this section, see F. Seppelt and G. Schwaiger’s Die Geschichter der Päpste. It contains more relevant historic details than the Oxford Dictionary of the Popes (yet the Dictionary is a far more recent publication). Since the sixth chapter deals largely with the time of the Crusades, both theology and history are essential for understanding religious leprosy subjects of that period. A remarkably large portion of the legendary medical patron saints originated in the East; similarly the translocation of Eastern cults and the adoption of Levantine medical knowledge may have influenced the developing Western European culture. In addition, the founding of new religious nursing orders brought changes in the twelfth and thirteenth centuries; on this, see for example, D. Marcombe’s Leper Knights: ἀ e Order of St. Lazarus of Jerusalem in England. Around 1200, these events triggered responses by the Latin Church that concerned the treatment of the leprous population, including the edicts of Lateran Councils III and IV and laws pertaining to the founding of leprosaria, all of which changed the fabric of European society for centuries to come. Although clinical leprosy was known in Europe since Roman times, circumstantial evidence supports the theory that crusader traffic contributed to the first “real” or “imagined” European health crisis of the Middle Ages.4 Franciscans and other mendicant orders were concerned with the physical and spiritual health of the poor and the sick, and over the centuries, as Christian theology

6 

Images of Leprosy

evolved, the relevance of intercessory saints rose; see J. Le Goff ’s ἀe Birth of Purgatory. These changes explain, for instance, the popularity of early modern altarpieces dedicated to St. Elisabeth of Hungary/ Thuringia who in actuality may have nursed (but not healed!) victims of leprosy. The sources of saints’ biographies are much too diversified to give even a brief review; only the most pertinent books are mentioned. Jacopo Voragine’s Golden Legend (circa 1260) gives a fairly comprehensive collection of some of the legends, though its influence on leprosy art is limited. The official versions of saints’ lives published by the Roman Catholic Church supply the most extensive compendia. These are the Acta Sanctorum (published in the seventeenth century) and the Biblioteca Sanctorum (1961–87). The final chapter, covering 1450 through 1750, presents a wide range of issues from theological to sociological questions, which in turn reflect scientific advances, economic conditions, and, above all, an innovative artistic evolution. Because of its format, this book can only accommodate a few well-documented masterpieces and some minor works. Monographs discussing individual artists, such as Rosselli, Bosch, Rembrandt, and Engebrechtsz, among others, are cited in that chapter. After 1500, when leprosy declined in Europe, fewer but more intricate leprosy subjects were commissioned. This period also produced a number of secular leprosy topics that appear primarily in prints and drawings (in many cases considered minor arts). Simultaneously, plague images supplanted leprosy themes in Catholic regions. Interestingly, in Protestant countries, leprosy subjects appeared to have increased briefly during plague years. In the northern regions, where Hansen’s disease lingered longer than in the South, questions on charity and on civic responsibility were raised. Since this era also coincided at times with the growth of urban and rural poverty, one finds even in the visual arts negative attitudes expressed toward the victims of leprosy; such sentiments are absent in religious subjects of the previous centuries. E  E  E On a personal note, working on this project with the enthusiastic help of my advisors and medical experts, Daniel H. Connor, M.D., and Patricia Gallinek, R.N., I became aware of the predicament of modern patients who are still fighting to retain their human dignity. Because in many

Introduction

 7

cultures leprosy victims are surrounded by fear and myths, the disease becomes a social as well as a medical condition. I am therefore determined, while maintaining a high level of academic scholarship, to assist in the elimination of persistent cultural prejudices that still surround Hansen’s disease. Hence, the outmoded English term “leper” will not be used except in quotations from scripture and other sources. I planned Images of Leprosy: Disease, Religion, and Politics in European Art as a companion book to the volume Images of Plague and Pestilence: Iconography and Iconology. While researching, I found only a few similarities, but instead found important differences surrounding the experiences of these two infectious illnesses—significantly the only illnesses depicted that incorporate implicit clinical features in their well-defined iconographic formulas. More important, since leprosy and plague patients were treated very differently, the images also served diverse functions within society (which will be contrasted in the appropriate chapters). Information gathered from a broad range of disciplines and periods—although relevant—may appear overly generalized to some specialists. Images of Leprosy is conceived primarily as a concise handbook for art historians. Medical historians, doctors and nurses, and students of social history might also find it useful because the book presents an illustrated history of this contagious disease that laid low the whole continent for many centuries. Drawing attention to details recorded in historic works of art, such as the physical appearance of the leprosy-stricken, and to discussions of diagnostic procedures and society’s efforts to prevent the spread of leprosy, can supplement information found in contemporary written sources.

Chapter 1

Leprosy Worldwide and the State of Modern Research Literature and the visual arts often use leprosy, a most devastating affliction, as an example of the worst fate that could befall a person. Since so many artworks allude to the condition, a brief excursion into the medical field is essential; however, this discussion will be limited to those issues pertinent to art historical discussions of leprosy and will therefore condense the extensive clinical information. Most historians are familiar with the schematic illustrations referring to leprous skin conditions as dot-like markers scattered over the patients’ faces and bodies. In the real world of infectious diseases and the current state of medical science, historians increasingly use epidemiological information to supplement their research into art’s enlightening depictions of leprosy victims. As early as the ninth century, works of art show that manifestations other than dermatological signs were recognized as characteristics of leprosy. When compared with clinical photographs, these images provide valuable information about the medical knowledge of the period in which the art was created.

Medical Research Leprosy is a chronic infectious disease caused by the bacillus Mycobacterium leprae. It has a number of unique features, some of which were observed long before the pathogen was discovered in 1873 by Norwegian physician and bacteriology pioneer Gerhard Henrik Armauer Hansen (thus the disease is referred to as Hansen’s disease or HD).1 The modern classification system of Hansen’s disease developed by Ridley and Jopling requires microscopic examinations of the affected cells and thus is far too sophisticated for a discussion of medieval imagery of leprosy.2 Therefore, it is convenient to think of Hansen’s disease as consisting of 8

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two clinical types: “tuberculoid leprosy” and “lepromatous leprosy,” the so-called polar or opposite forms. When the leprosy bacillus invades the body of a person predisposed to the most aggressive form, the lepromatous type of leprosy, the bacilli proliferate without restraint because the body’s immunological defense against M. leprae is absent. Even though the bacilli divide at a slow rate (about eighteen to twenty days), an immense number of bacilli eventually accumulate; therefore, this type is also called “multibacillary” or “low-resistance” HD. Lepromatous leprosy is characterized by massive involvement of the skin, with a symmetrical (bilateral) distribution. The raised nodules (small masses or lumps) tend to become confluent; they are solid (about the consistency of cool butter) and contain enormous numbers of leprosy bacilli. According to Daniel H. Connor, MD, if a nodule were pierced with a sharp instrument, it would not collapse, since the contents are not liquid or pus. Without specific antimicrobial treatment, patients with this form of leprosy will die within a few years. This is the type of leprosy that most Europeans are prone to develop. Modern scientists have observed regional and ethnic differences, though the reasons for such diverse experiences are still under investigation.3 Tuberculoid leprosy (also called “pauci-bacillary” or “high-resistance” leprosy), the most benign form on the spectrum, contrasts sharply with lepromatous leprosy. The first clinical sign of tuberculoid leprosy may be a single lesion on the skin. It is usually a flat or slightly raised patch. It may be depigmented (marked by absence or loss of pigmentation in skin or hair) and have slightly raised margins; its center may be hypesthetic (having impaired tactile sensibility) or worse even, anesthetic (having complete loss of sensitivity). If there are multiple lesions, they are asymmetrically distributed. In tuberculoid leprosy, the macrophages (cells that contain M. leprae) identify M. leprae as foreign and begin to destroy the bacilli. Therefore, untreated tuberculoid lepromasy may be self-healing; that is, the lesions may gradually disappear even without treatment. Illustrations of patients suffering from tuberculoid leprosy can be found in Binford and Connor, Pathology of Tropical and Extraordinary Diseases (figs. 6.1, 6.8, 6.9, 6.10, 6.11). It is difficult to diagnose tuberculoid leprosy in art, because the manifestations resemble too many other skin conditions.4 As mentioned, this type of leprosy can be at times self-healing, and “drug-induced isolation” (the state after medical treatment when the patient no longer tests positive for HD and is no

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longer infectious) works much better on tuberculoid leprosy than on the more dangerous lepromatous counterpart. In lepromatous leprosy, the macrophages seem to be blind to the bacilli and do not destroy them, as happens in tuberculoid leprosy. Thus the outcome of the battle depends on the relative efficiency of the invader (bacilli) and the defender (the human body).5 Whereas lepromatous patients have poor immunity and tuberculoid patients have good immunity, borderline patients, a subcategory in the wide spectrum, can simultaneously exhibit the characteristics of both polar forms. The important point is that patients can develop a type of leprosy for reasons that are not obvious; for example, children of a parent with one type of leprosy can develop another form of leprosy later in life. The exact mechanism of leprosy’s transmission is still much debated, with medical doctors proposing that prolonged contact and/or nasal secretions may cause the spread of M. leprae from person to person. Because M. leprae cannot be cultured in vitro, its transmission is still poorly understood and skin-to-skin transmission has not been excluded. According to Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases (7th ed.), “Other modes of transmission such as soil, insect vectors, and exposure to infected animals (armadillos, chimpanzees, monkeys) remain speculative.”6 Leprosy is not sexually transmitted and is not hereditary; however, the common belief, noted by Albertus Magnus in the twelfth century, that “a leper begets a leper” seemed valid for many centuries. Modern researchers speculate that close contact with an infected parent and the fact that mothers’ milk contains many bacilli may have increased the chance of infection in early childhood. Genetic factors are now considered as well by modern scholars.7 A large percentage of persons absorbing leprosy bacilli do not develop HD. Their immune system prevents the replication. In fact, roughly 95 percent of people have an inborn (natural) immunity to leprosy. Among the unusual characteristics of the disease is also the apparent randomness of infections and the long incubation period. M. leprae has the slowest regeneration time of known human bacterial pathogens. It involves mostly the “cooler tissues of the body” and produces a variety of manifestations.8 The apparent haphazardness of contracting leprosy was frequently discussed in premodern literature; for lack of a better explanation, it was interpreted as “the will of the Lord.”

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To understand historic images of leprosy victims, it is important to know that the bacilli attack many organs. The microbe’s predisposition for invading and destroying nerves, however, is the feature that causes so much catastrophic damage: paralysis, anesthesia, loss of digits, contraction deformities, damage to the eyes, and much more. Today the deformation of hands and feet is attributed in part to the resorption of bone, which can be readily observed when paleoanthropologists unearth skeletons.9

Photographic Studies of Patients Displaying Signs of HD Even with a detailed understanding of the lesions of Hansen’s disease, it may be difficult for a layperson to picture lepromas without the help of visual material. To illustrate the diversity of leprosy manifestations, a

Fig. 1.1 (above left)  Patient with Lepromatous Leprosy, 1931. (Photograph by Chapman H. Binford, M.D., 1931. © Daniel H. Connor, M.D. Used with permission.)

Fig. 1.2 (above right)  Same Patient with Lepromatous Leprosy, 1933. (Photograph by Chapman H. Binford, M.D., 1933. © Daniel H. Connor, M.D. Used with permission.)

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few clinical photographs are selected as comparisons; they will be cited throughout this book. Figures 1.1 and 1.2 portray a young patient in Hawaii. Taken in 1931 and 1933, before sulfone drugs were introduced, these images demonstrate the rapid progression of confluent lepromatous leprosy. Only two years after the first image, the patient is barely recognizable since lepromatous nodules disfigure the patient’s face. The young man, now fifteen years old, seems to have aged far more than two years; he displays characteristic features of lepromatous leprosy, with disfigurement of the forehead, especially around the eyebrows, recession of the hairline, the saddle-like thickening of the nose, and the enlarged earlobes. On the young man’s arms there are ulcerated lepromas; such wounds on arms and legs are common and were considered typical warning signs. European medical practitioners had observed centuries ago that features of leprosy usually—but not always—appear first on the face and that leprosy had countless different non-dermatological manifestations. Over the centuries, physicians have frequently reported hoarseness, although externally invisible, which is caused by the obliteration of vocal cords and changes in the trachea and larynx. Before modern medication, laryngeal or tracheal obstructions could suffocate patients. This was indeed the cruel fate of the young Hawaiian patient.10 Figure 1.3, taken in Manila in 1899, shows a woman with a severely crippled hand; it is sharply bent at the wrist, her fingers are completely deformed, and her fingertips and nails are missing. In addition, the woman seems to have gone blind; in many cases, the leprosy bacillus attacks the patients’ eyes and eyelids. Her facial features, as well as those of the previous victim, can be characterized as facies leprosa or leonine, as the faces of advanced leprosy patients were described during the Middle Ages. Figure 1.4, taken in Africa before leprosy medication became available, shows severe deformities of the hands and feet. The patient’s arms look very different from the symptoms seen in figures 1.2 and 1.4. No lepromatous blemishes mar the patient’s face; only some prominent white spots appear, distributed asymmetrically on his left leg, and large areas of hypopigmentation (loss of skin color) can also be detected. The most significant symptoms are noticeable on the man’s hands and feet; the patient has lost his fingers and toes and shortening the digits has left him with characteristic elephantesque stumps. Patients with similar appearance were reported in other parts of the world as well.11

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Fig. 1.3  Leprosy Case Observed on Street. (Photograph by Frank R. Keefer, 1899; courtesy of National Library of Medicine, Bethesda, MD.)

Researchers found no curative treatment for leprosy until the middle of the twentieth century.12 Though lepromatous leprosy itself is usually not lethal, the disease can kill, with most untreated patients dying of complications. Medicine, however, seems to be finally winning the battle by reducing the astronomically large numbers of leprosy patients in many parts of the world. In 2008, only three countries—Brazil, Nepal, and Timor-Leste (East Timor)—reported more than 1 case of HD per 10,000 people. It is interesting to note that medical historian Luke

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Fig. 1.4   Patient with Late Neural [Borderline?] Leprosy. (Photograph by Daniel H. Connor, M.D., August 1968. Used with permission of photographer.)

Demaitre estimates similar figures for the city of Bruges in the early fourteenth century: 3 cases per 10,000 people.13 The first curative drugs were developed in 1940, and since the 1980s, there has been a global change in the treatment and management of Hansen’s disease through multidrug therapy, or MDT (dapsone, rifampicin, and clofazimine, plus thalidamide) and management programs that can significantly reduce disability. Since 1982, science has been successful in halting the global

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spread of Hansen’s disease by decreasing the number of new patients worldwide by 20 percent per year. (Today about 1 to 2 million are said to be infected worldwide, but exact numbers are not available.) Early detection and the effectiveness of multidrug therapy render the patients, after a certain period of time, no longer infectious. Clinical tests can confirm an initial diagnosis or a relapse of the disease; however, physicians have to be aware that the stigma of being tested—even if the results are negative—can be devastating for the patient. Unfortunately, by the time the disease is diagnosed, there may already be damage to the body that cannot be completely reversed by medication. Documentary Photographer Patricia Gallinek, R.N., shared her experiences, visual documents of her work in Asia, and information about the rehabilitation programs that include surgery on damaged hands and feet. Hand function can be restored up to 80 percent through surgery, and physical and occupational therapy. The most common reason for amputation of a lower limb is osteomyelitis (uncontrolled infection of the bone), but damage to the feet can also be caused by loss of sensation because patients can be unaware that they are damaging their skin and bones and other tissue when walking. Following amputation, a patient will be fitted with a prosthesis and given physical therapy (see fig. 1.6). After these procedures, patients can return as able-bodied citizens to their communities; however, because of centuries-old prejudices, many former patients prefer to take employment in the more sheltered environment of leprosy clinics and hospitals rather than face humiliation by the ill-informed public. The photographs demonstrate how different clinical manifestations of leprosy can be and how the various stages of the illness can be diagnosed, even without modern technology. Yet at the same time, the profusion of signs also highlights the difficulties of diagnosing Hansen’s disease correctly—then and now. Since modern drugs can alter the color and form of the skin lesions, only photographs taken prior to 1940 or of contemporary patients before they begin treatment can be used as valid comparative material for historic imagery. A photograph taken in India and published by the Global Project of the History of Leprosy shows a leprosy patient being escorted by his family to the treatment center. Although the man does not display any outward symptoms, he has to brace himself on his long staff. As early as the ninth century, Western art recorded similar scenes, demonstrating people’s awareness that leprosy, which often first

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attacks nerves on the hands and feet, can cause physical problems that might make a stabilizing device necessary (see fig. 2.4, p. 32).14 Deformation of a hand is one of the early warning signals of leprosy, as seen in children suffering from what is sometimes referred to as a “claw hand” because the patient is unable to straighten the fingers. Figure 1.5 shows a modern reconstructive surgeon examining a young patient with flexion deformity of the hand alongside a detail of a fifteenth-century painting depicting the similarly deformed hand of a young leprosy patient (for the complete image, see fig. 3.4, p. 61). The two claw hands are remarkably similar, except that modern medical science and innovative physicians’ care can now improve the patients’ future.

Fig. 1.5   Reconstructive Surgeon Examines Young Patient with Flexion Deformity of Hand. A comparison with a detail of a fifteenth-century painting (fig. 3.4). (Photograph courtesy of Documentary Photographer Patricia Gallinek, R.N., and The Leprosy Mission South Asia.)

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Fig. 1.6  Trained Technician with The Leprosy Mission Instructs Patient in Care of Artificial Limb. (Photograph courtesy of Documentary Photographer Patricia Gallinek, R.N., and The Leprosy Mission South Asia.)

In the last clinical photograph (fig. 1.6), a technician at The Leprosy Mission is instructing a patient in the care of an artificial limb that will greatly enhance his mobility.15 The leg was amputated well below the knee; most leprosy infections are found in the lower part of the leg (see the bandage in fig. 3.4, p. 61, which bares the knee of the young man with flexion deformity). The study of modern victims suffering from HD will be of great value to the readers when analyzing the art in the subsequent chapters. In addition, since the book is dedicated to an historic approach, a few theories on the origin of leprosy should be examined.

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ἀ eories on the Origin of Hansen’s Disease and Its Global Spread DNA testing of bones and paleopathology are important methods used to identify ancient diseases. According to some researchers, Hansen’s disease originated in East Africa or in the Middle East, and then spread from there to East Asia.16 The date when leprosy arrived in Europe is still being debated, although it is generally assumed that the army of Alexander the Great brought HD back from India; after that, it seems to have spread throughout the Roman Empire. The oldest uncontested physical evidence of leprosy was discovered on Egyptian skeletons of the third century bce. This hypothesis on African origins was challenged or at least revised in 2009 when scientists published their findings on a four-thousand-year-old skeleton found in the northwestern part of the Indian subcontinent, at the ancient site of Balathal. Although the bones have not yet been subjected to DNA tests, the scientists report that the bones bear markings of leprosy.17 If the Indian skull proves to be leprous, it will confirm backdating the earliest written sources describing Hansen’s disease to ca. 1550 bce.18 The Sanskrit hymns of the Atharva Veda, composed at that time, discuss health problems that some scholars believe refer to leprosy. Without confirmation that the disease in India dates back that far, the Sushruta Samhita, which dates to 600 bce, has been considered the oldest written Indian document to describe manifestations attributed to leprosy—loss of sensation, deformities of limbs, loss of fingers, ulceration, and sinking of the nose. A Chinese document of the third century bce includes an astute clinical description that stressed loss of hair and eyebrows, hoarse voices, destruction of nostrils, and problems with the patients’ legs, all of which are associated with leprosy.19 Many of these symptoms are illustrated in figures 1.1 through 1.6. Although it is not a medical description, one of the oldest texts pertinent to our discussion is Leviticus 13:9–46 (see appendix A), which describes an affliction called in Hebrew sara’at, later translated into Greek as lepra (meaning “scaly”). According to the laws of Leviticus, sara’at rendered the victims “ritually unclean,” and sufferers were excluded from society for the duration of the illness. The outcasts could be declared “clean” by temple priests when the symptoms cleared up; however, occasionally a patient, such as King Uzziah, remained a “leper” the rest of his life (2 Chron. 26:16–23). While the biblical disease is often referred to as “leprosy,” Bible scholars and historians question whether

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Hansen’s disease is actually in any form related to biblical lepra. There is also little evidence that medieval and early modern European medical literature—or even the visual arts—based its discussions or depictions of leprosy on Levitical passages.20 It is not known when people began to identify clinical leprosy with the state of health described as sara’at in the Old Testament. According to physician Keith Manchester, “the clinical disease of leprosy may have been included with several other states in the term Tsara’ath.”21 The Old Testament does describe some manifestations that resemble lepromatous signs, such as hair loss and deep flesh wounds (Lev. 13:13–14, 40), but it is important to note that the Bible does not discuss hypesthesia, anesthesia, claw hand, drooping eyelids, paralysis, and other symptoms prominently associated with Hansen’s disease. DNA studies recently provided some indication that by the first century ce, the biblical affliction known as sara’at could have, theoretically, included Hansen’s disease. In 1994, an interdisciplinary team that included A. Rafi, Mark Spigelman, J. Stanford, and H. H. Donoghue identified leprosy on a sixth-century ce deformed bone found in a cemetery at the St. John the Baptist monastery in Israel. Interestingly, St. John the Baptist monastery is also the site traditionally associated with the biblical story of Christ healing a leper.22 A few years later, Spigelman and Donoghue examined a corpse found in the Tomb of the Shroud near the cemetery in Jerusalem known as “Field of Blood”; the remains had been laid to rest in a specially sealed rock-cut chamber, where it was customary to place the deceased until the flesh had dissolved, at which stage the bones were normally gathered and placed in an ossuary. This particular person, however, had not been subjected to a reburial. While debating why such an exception was made, Spigelman suggested examining the body for leprosy, assuming this special treatment indicated that the man might have been infected with HD (see appendix for Josephus’s description of the leprous King Uzziah’s isolated burial in his own gardens and 2 Chron. 26:23). The team was successful in identifying the first-century ce remains as the earliest confirmed case of leprosy in Jerusalem; they published their results in 2009.23 Thus, one can possibly assume that Hansen’s disease had spread to the Middle East at least by the first century bce.24 At what time the visual convention developed that identified clinical leprosy with the biblical affliction in the Old Testament is still open for debate;25 however, an analysis of select New Testament illustrations

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reveals some novel observations that seem significant for the origin of this European visual tradition. Scenes of Christ healing a leper produced during the ninth and tenth centuries represented victims who display, in addition to the customary dermatological markers, seemingly unrelated symptoms that are characteristic of clinical leprosy. These primitive, early empirical notations of HD manifestations will be discussed in chapter 2 in greater detail. Because this volume explores the historical background of clinical leprosy in Europe—a difficult task since scholars cannot quantify the patients in centuries past, we have to turn to a study that began even before Hansen identified the bacillus Mycobacterium leprae. Thanks to the Norwegian Leprosy Research Project, begun in 1856 when a royal decree made registration of leprosy victims obligatory, we have access to some pertinent figures. From 1856 until 1920, roughly 8,000 leprosy patients were minutely documented and studied. Remarkably, incorrect diagnoses were fairly rare, even before microscopic examinations became feasible. Lorentz Irgens, M.D., author of Leprosy in Norway: An Epidemiological Study Based on a N ational Patient Registry (1980), suggests that some external influences can make people of certain regions more prone to leprosy. According to his analysis of the now-computerized data, Norway was divided into areas ranging from endemic to completely unaffected areas, such as the large region around Oslo, the most densely populated city (see fig. 1.7).26 A similar study conducted in the area of Bombay confirms that tremendous differences within endemic regions can coexist in close proximity. Today, Hansen’s disease is considered essentially a rural or “village” disease. Inquiry into the environmental influences in the spread of leprosy is a recent achievement. Scientists take into account climate, solar radiation, humidity, and specific vegetation, such as sphagnum, a moss that harbors mycobacteria. In the future, these new scientific approaches might be able to determine how agricultural developments of certain environments can influence the probability of contracting HD. Irgens describes the situation in rural Norway in the nineteenth century as a time of progress in cultivating new farmland. Norway’s barefoot peasants deforested large areas, drained bogs, and tilled topsoil for the first time. According to his inquiry, “the risk of contact with such sources [growth of mycobacteria in the ground] diminished since the use of boots, even in the summer, became more and more common.”27 The National Patient Registry also provides data supporting the premise that the physical

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Fig. 1.7  Map of Norway, Average Incidence Rates of Leprosy by County, 1851–1920. (Reproduced from Irgens, Leprosy in Norway, fig. 1, with permission of Lorentz M. Irgens and the National Leprosy Registry of Norway.)

isolation of infectious patients in special leprosy hospitals was an important cause of the initial decline in incidence rate during the observation period. However, Irgens emphasizes that today, medical treatment represents the primary means of preventing the spread of HD and isolating patients is an outmoded practice. Finally, it should be noted that there are some similarities and differences between tuberculosis and leprosy, as well as the possibility of co-infection. The tubercle bacillus is closely related to M. leprae; it is

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a mycobacterium, which can exist in nature outside a living body, and the two types of bacilli may have evolved from a common mycobacterial ancestor. Both infectious diseases are ancient; tuberculosis gained its prominence during the Neolithic age when the Middle Eastern citystates rose to power. Some researchers suggest that early farmers, by cultivating the ground, exposed their lungs to dust containing mycobacteria.28 Unlike leprosy, tuberculosis is highly contagious, sometimes killing very quickly and dominating crowded settings. The proceedings of a 2005 interdisciplinary research project, “Co-infection of Mycobacterium tuberculosis and Mycobacterium leprae in human archaeological samples: A possible explanation for the historical decline of leprosy,” reports that “Hansen [in 1895] noted that tuberculosis was a major cause of death in his leprosy patients in Oslo.” Furthermore, the study on co-infection also advances the hypothesis that tuberculosis was in part responsible for ending leprosy in many regions of the world, especially Europe.29 A number of scholars support this theory and argue that, on the one hand, tuberculosis, a more virulent illness, killed people before they developed the final stages of leprosy; on the other hand, tuberculosis might have been instrumental in building antibodies against Hansen’s disease in the general population.30 Both illnesses remain grave threats worldwide. The global spread of leprosy today affects primarily the Asian, African, and South American continents. The state of Hansen’s disease in the continental United States is rarely discussed. Between 1835 and 1970, leprosy was endemic in southern Louisiana, but the region showed a decrease in incidences of the disease even before the use of drug therapy. Global human migration meant that cases of leprosy increased in other areas of the United States, like Texas, but by no means at an alarming rate. Baton Rouge’s National Hansen’s Disease Clinical Center has been acknowledged worldwide as a leader in research into multidrug therapy, and is visited by numerous foreign patients seeking a cure from HD.31 The history of leprosy in Hawaii, now part of the United States, is intrinsically linked to the personality of Belgian friar Father Damien of Molokai (1840–89; canonized in 2009). The first case of Hansen’s disease in Hawaii was reported in 1848 (most likely introduced from China) and the illness spread rapidly on the islands. The government founded a leprosarium in 1866, and Father Damien arrived seven years later at the age of thirty-three to take charge of the physical and spiritual wellbeing of the settlement, which grew over the next years to six hundred

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patients. Father Damien experienced the first symptoms of HD in 1884, but remained mentally and physically active for several more years, only reaching the “helpless stage” one year before his death in 1889. Hansen’s disease was—and still is—a global issue, but leprosy is depicted almost exclusively in the art of the Latin West. Although some Byzantine illustrations of biblical stories display generic dots on the leprous figures, their depictions are not included in this volume because the Byzantine culture did not attempt to investigate authentic clinical signs. Abundant visual documents characterizing specific illnesses in European art offer a unique opportunity to study these images and learn how people of the medieval and early modern periods handled the tasks of diagnosis, therapy, and prevention. These investigations help reconstruct the history of leprosy in that region and shed light on society’s attitudes toward the sick.

Chapter 2

Historiography of Hansen’s Disease in Europe It is difficult to ascertain when leprosy was introduced into the European regions of the Roman Empire; however, the disease had reached England by the fourth century ce at the very latest. It has been well established that by the end of the first millennium, the illness was known from Italy to Sweden and from Hungary to France, putting to rest, once and for all, the hypothesis that the sickness had been introduced by returning crusaders. One of the most challenging aspects of discussing diseases in historical context is establishing how much medical knowledge was available at any given time. Did people comprehend the danger of being exposed to a contagious patient? How did they diagnose and treat illnesses? It appears that, around the beginning of the common era, people in Rome had a rudimentary knowledge of practical medicine and even had some theories of how epidemics spread. Classical Roman authors and physicians did not attach a moral stigma to contracting disease. Aretaeus of Cappadocia (second century ce) described elephantia or elephantiasis (ancient terms for leprosy) as a frightening, physically disfiguring disease that caused family members to abandon their kin: “there is a fear that the illness may be communicated.”1 Over the centuries, Greek and Roman authors collected some empirical knowledge of epidemiology that relates to the clinical study of leprosy. For example, they were aware that people who nursed the infected were very likely to become ill themselves.2 Lucretius Carus (99–54 bce), expounded, in his De rerum natura, several theories on the proliferation of sickness. In book 4, Lucretius wrote that elephantiasis existed only in Egypt, but he also warned that strange illnesses could travel via air, “and when we draw a breath we thereby draw disease into our bodies.”3 Marcus Terenitus Varro (also called Varro Reatinus, 116– 27 bce), one of the most brilliant Roman scholars, anticipated modern 24

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science when he warned that precautions needed to be taken around swampy regions because “they breed certain minute creatures which cannot be seen by the eye” and these are airborne and might enter the body “through the mouth and nose and cause serious diseases.”4 One has to turn to the visual arts as the only ancient primary source that can confirm if people really did take precautions to avoid infection, namely protecting themselves to avoid breathing in airborne diseases. In fourth-century Rome, such medical theories of contagious air that could enter the body via mouth and nose may have spread in educated circles, such as the one of the Roman prefect Junius Bassus, who died in 359 ce. His carved marble sarcophagus is probably the oldest known documentation that Romans attempted to protect themselves against the danger of contagion. The tomb reliefs in the first bay on the bottom left show a scene depicting the sickness of Job. In ἀ e Suffering Job and His Wife (fig. 2.1), Job’s wife stands next to her seated husband; she protects her mouth and nose by lifting the folds of her garment, presumably to avoid infection. Scripture does not identify Job’s illness, but it is described in the Vulgate as “percussit Iob ulcere pessimo a planta

Fig. 2.1  ἀe Suffering Job and His Wife. Detail of Sarcophagus of Junius Bassus, 4th century ce, carved marble. Vatican Palace, Vatican State. (Image courtesy Alinari/Art Resource, NY.)

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pedis usque ad verticem eius” (Job 2:7). This description of ulcerated wounds covering the poor man from the bottom of his feet to the top of his head brings to mind the symptoms of leprosy patients. Although it is not commonly known, deep wounds on foot soles can be counted among the many signs characteristic of Hansen’s disease (illustrated in a number of modern medical textbooks). The biblical text does not mention stench and the pose of Job’s wife does not imply disgust; she merely seems to be attempting to prevent infection via mouth and nose. This pose was repeated on several late Roman sarcophagi, and by the ninth century at the latest, Byzantine conventions adopted this same gesture.5 In one form or another, this tradition continued in the Latin West for over a millennium, indicating avoidance of infection via the respiratory system. The quaint pose surfaces only in scenes dealing with Job’s illness, leprosy, and plague. In depictions of the resurrection of Lazarus, the gesture seems to indicate fear of infection from a corpse rather than from a diseased patient, and may be connected to the ancient theory of miasma—poisonous vapor or mist filled with particles from decomposed matter (miasmata).6 Often imagery of leprosy implied that people had to protect themselves against the contagious breath of leprosy victims. Such a scene is placed in the very center of a 1493 Nürnberg print titled Annual Leprosy Inspection (fig. 2.2). The multiscene woodcut shows a priest hearing the confession of an afflicted man. The cleric covers his nose and mouth with a very large cloth; the penitent’s sickness is indicated by skin blemishes, a cane, and a clapper.7 Contemporary with this print, even predating it by two years, is the woodcut Doctor’s Visit to a Plague Victim, which was first printed in Venice in 1491. The image was republished with revisions in Antwerp in 1512, demonstrating more specific implements to prevent infection against bubonic plague such as a vinegarsoaked sponge the attending physician presses over his nose and mouth. Furthermore, the woman bringing food to the patient and the boy carrying a container for a urine flask squeeze their nostrils shut to guard themselves from breathing in the pestilential air as best they can.8 Anxiety about contagious airborne sicknesses being transmitted via mouth and nose, as first proposed by Lucretius Carus and Varro Reatinus, survived since antiquity in the fine arts. The specific protective gestures that first surfaced in the fourth century were retained in Western art until the eighteenth century (see fig. 3.1, p. 54). Considering

Historiography of Hansen’s Disease in Europe

Fig. 2.2  Annual Leprosy Inspection, 1493, woodcut from broadsheet, Nürnberg. Reproduced in Casimir Tollet, Les edifices hospitaliers depuis leur origine jusqu’à nos jours (Paris, 1892). (Image courtesy of National Library of Medicine, Bethesda, MD.)

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regional differences and the state of medical science, the consistency with which these gestures were preserved is remarkable. The images themselves present some evidence that there must have been more concern regarding the physical danger of transmission from person to person, particularly through the respiratory tracts, than previously assumed. It is difficult to assess how much was owed to ancient theories and how much new empirical experiences contributed to that process. Even today, the question of transmission of HD is still a matter of debate, with cutting-edge science assuming that “the predominant mode of transmission is likely to be through respiratory droplets or nasal secretion.” Similarly, pneumonic plague was always considered the most lethal form of this devastating disease.9 It is fascinating to compare modern swine flu masks and other current protective devices against infectious illnesses with the earliest, rather primitive methods.

Leprosy in Europe during the Middle Ages Because our topic developed from biblical subjects, it is important not only to explore the Roman literature but also to mention briefly ancient Hebrew attitudes toward infectious diseases. In contrast with pagan Rome, the writers of the Old and the New Testaments associated moral shortcomings with disease, as Jewish historian Flavius Josephus (ca. 37– ca. 100 ce) indicated in some of his writings. According to Samuel Kottek (Medicine and Hygiene in the Works of Flavius Josephus), Josephus, in his Antiquities of the Jews, addressed two diverse audiences: Greek-speaking Hebrews and Romans. For his own countrymen, he emphasized that an angry Lord caused disease, while for the more enlightened Romans, he added physical causes, including climate, diet, insufficient medical care, and the psychological effects of high mortality, among others.10 Josephus also mentioned some of the Levitical purification requirements; however, he limited his discussion to hair cutting and prescribing baths in spring water. The famous historian wrote primarily about leprosy as a rebuttal to accusations by Egyptian author Mantheo (third century bce) that the Israelites were expelled from Egypt as “unclean” people. Josephus argued that Moses, in an effort to prevent lepra from spreading in the Jewish camp, introduced harsh laws that excluded the sick from the community of the healthy.11 After the fall of the Roman Empire and up until about 1000 ce, medical science and the ancient traditions used to contain infectious

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diseases were largely ignored. Medical schools, except within the boundaries of monastic orders, had not yet been established. Medical treatises in the West were generally antiquated and limited to the teachings of Hippocrates (460–370 bce) and Galen (129–207 ce) and based on the balance of the four humors.12 When examining historical tracts, it is important to understand the medical terminology of the time. In the period covered in this book, European scholars used the Greek word “elephantiasis” to refer to leprosy; however, this should not be confused with the modern tropical illness called elephantiasis (or lymphatic filariasis, a parasitic disease). The origin of the word is intriguing since the elephant is not native to Europe. Aretaeus explained the name “elephantiasis” as expressing the analogy of the thickening skin experienced by leprosy victims. Many old European treatises added further comments explaining how the largest beast, the elephant, resembles the dreadful, overpowering illness. Looking at the photograph portraying the patient diagnosed with late neural [borderline?] leprosy (fig. 1.4, p. 14) whose resorbed hands and feet are reduced to stumps, one could well imagine that people in Africa and Asia (where the indigenous population suffered more from tuberculoid or borderline leprosy than from the lepromatous type) likened leprosy to that animal. One could assume that similar stumplike manifestations were known in antiquity and that this phenomenon may have been originally responsible for the coinage of the term “elephantiasis.”13 Josephus translated the Hebrew word “sara’at” into Greek as “lepra” (meaning “scaly”). St. Jerome (ca. 347–420) used the same term, and most nonmedical treatises used the word “lepra” as a designation for the biblical disease. Medical authors of the Middle Ages, on the other hand, were aware the word “lepra” generally denoted a more benign illness than what is known today as Hansen’s disease; they used the term “elephantiasis” to indicate that the patient suffered from an incurable ailment.14 One of the earliest medieval European manuscripts, Das Lorscher Arzneibuch, written in Latin in the eighth century, used the latinized idiom “elephantia.” The text mentioned briefly that the patients’ symptoms consisted of foul smell, changes in the appearance of eyes, loss of nails on hands and feet, etc. (see figs. 1.3, p. 13; 1.4, p. 14).15 Although Hansen’s disease had been present in Europe since Roman times, for unknown reasons, a heightened awareness of leprosy topics seems to begin only with the ninth century. It is difficult to judge

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whether an increasing number of patients triggered this phenomenon or if it merely reflected a greater interest in medicine. A third possibility could be religious in nature. The biblical images may have been intended to represent Christ’s compassion toward the “lepers,” which differed from the more austere attitude expressed in the Old Testament. Artworks of the Carolingian period not only depicted more leprosy subjects but also represented the patients with symptoms that let us recognize, for the first time, some of the cardinal manifestations of Hansen’s disease, including skin afflictions, loss of voices, paralysis, and hair loss. The art of the Carolingian renaissance in general appears to mirror renewed interest in classical literature, as well as concerns for public health. The Carolingian rulers seemed to emulate imperial Rome, though under the auspices of the Christian concept of misericordia (Christian compassion). Progressive emperors like Charles the Bald had court physicians, some of whom may have been recruited from the Middle East or possibly from Muslim Spain, where manuscripts written in Arabic, Hebrew, Greek, and Latin were available.16 Two of the earliest known medieval objects that attempt to portray a specific illness (e.g. Hansen’s disease) are here analyzed solely in regard to medical questions. The cover of Codex Aureus of St. Emmeram (fig. 2.3), dated to circa 870–75, includes a gold relief of Christ Healing a Leper (fig. 2.4) that shows a man approaching Jesus.17 The innovative metalwork does not render the infectious markings as generic dots. Instead, close inspection of the victim’s symptoms reveals that they resemble some of the same markers of Hansen’s disease observed in figures 1.2 and 1.3 (pp. 11, 13). Irregularly shaped, yet carefully modeled, nodules cover the man’s body symmetrically (left and right). In addition, the invalid supports himself on a long staff wedged in his left armpit; the need for a crutch while walking implies that the patient might be afflicted with paralysis or other crippling deformities that on the surface appear unrelated to the skin blemishes (see crutch under leprous man’s arm on right side of fig. 2.4). It is noteworthy that neither Western medical treatises of the ninth century nor scripture allude to nerve damage or to the use of stabilizing devices when describing lepra or elephantiasis. Most important, a computer enlargement of the face (fig. 2.5) achieved by Daniel H. Connor, M.D., enabled him to diagnose the characteristic leproma on the ridge of the victim’s nose—which in time would lead predictably to the distorted facial features. One can also

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Fig. 2.3  Cover of Codex Aureus, ca. 870, gold relief. (Image courtesy of Bayerische Staatsbibliothek, München, Clm 14000.)

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Fig. 2.4  Christ Healing a Leper. Detail of cover, Codex Aureus, ca. 870, gold relief. (fig. 2.3). (Image courtesy of Bayerische Staatsbibliothek, München, Clm 14000.)

observe on the victim’s chin, instead of a beard, a row of deep indentations. My first assumption was that these holes were prepared as spaces where the metals to shape a beard could be inserted—now I am more inclined to think of the holes as an indication of hair loss.18 The Carolingian relief presents evidence that more empirical knowledge was available than historians had previously assumed. Charles the Bald’s personal physician, Zedechias the Jew, for example, might well have

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Fig. 2.5  Leper’s Head. Detail of fig. 2.4, Christ Healing a Leper, cover of Codex Aureus, ca. 870, gold relief. (Image courtesy of Bayerische Staatsbibliothek, München, Clm 14000.)

served as a consultant for the medical details, such as the correct placement of the nodule, suggestions of paralysis, and possible hair loss. His knowledge may have been based on observations of living people suffering from Hansen’s disease. A very different medium can be studied in the manuscript of the Gospel Book of Otto III. The folio Christ Healing a L eper was illuminated around the year 1000, most likely in the Benedictine Abbey of Reichenau, a renowned medical center (fig. 2.6). The miniature highlights additional aspects of leprosy. The large folio narrates the story of the miracle in two separate scenes.19 The upper register depicts Christ’s

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Fig. 2.6  Christ Healing a Leper, from Gospel Book of Otto III, ca. 1000, book illumination. (Image courtesy of Bayerische Staatsbibliothek, München, Clm 4453.)

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encounter with the victim. Jesus extends his right hand in blessing and advances toward the man who bows before the Lord. The sick supplicant’s facial complexion is dark; his head and body are covered with skin blemishes. Significantly, the man’s head is also characterized by a receding hairline; this feature can be compared with figure 1.2 (p. 11). The victim carries a horn slung over his shoulder; the infected population probably was required to carry such instruments at least since the ninth century to warn an approaching person of their affliction instead of using their voices to call out that they were “unclean,” as prescribed for the sick diagnosed with sara’at in Leviticus 13:45. The inclusion of a horn is noteworthy because it reveals the awareness of another important sign of Hansen’s disease, deterioration of vocal cords. Ancient literature mentioned “hoarse voices,” and additional evidence indicates that European authors too wrote frequently about the typical raspy voices of sufferers of leprosy. This would indicate that society at large, although lacking the knowledge of the pathogen’s existence, was familiar with some of the damage done by M. leprae and took steps to prevent contagion without straining the victims’ vocal cords. However, it should be noted that the Levitical tradition most likely demanded the use of sound-producing objects, such as horns, bells, rattles, and clappers. In contrast, other infectious diseases (for example, most prominently plague) developed visual warning signals, the colors white and yellow being preferred.20 A scene in the lower part of the illumination depicts the second half of the story, which William B. Ober, M.D., refers to as “one of the most striking ‘before and after’ pictures of the epoch” (fig. 2.7).21 The healed patient appears again, dramatically changed in his physique and in new elegant attire. Clinically significant, the previous sufferer of lepra has regained a full head of hair; he now resembles the young apostle standing behind St. Peter. His unblemished skin, with its healthy color restored, indicates that this is a cleansed person. The seemingly small changes in the victim’s physical features are remarkable because, as noted in chapter 1, loss of facial hair, leonine faces, changes in pigmentations, and loss of voice are some of the many characteristics of leprosy, and since few, if any, of these manifestations were mentioned in contemporary medical treatises, we have to assume that they are based on observations of contemporary leprosy patients. Perhaps as leprosy

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Fig. 2.7  Comparison of two details from Christ Healing a Leper, from Gospel Book of Otto III, ca. 1000, book illumination. (Images courtesy of Bayerische Staatsbibliothek, München, Clm 4453.)

spread, or at least awareness of the scourge increased, the subject gained prominence. Today, conventional wisdom assumes that the Bible used the term “leprosy” (sara’at) as a generic reference to a number of skin diseases that made its victims ritually unclean. However, a comparison of the Carolingian relief and the Ottonian book illumination with late nineteenth- and early twentieth-century photographs of patients with clinical leprosy demonstrates that, by the ninth century, people associated the biblical disease with a number of non-dermatological manifestations as well. Closer examination of the patients’ symptoms in the rather primitive-looking portrayal of people stricken with leprosy from before 1000 ce indicates that the illness depicted in New Testament scenes was clinical leprosy. Earlier scholarship overlooked these astute empirical observations in medieval works. Strong visual evidence (apart from the scientific proof supplied by paleopathological scholars) indicates that Hansen’s disease was entrenched in central Europe during the first millennium ce; however, this discovery does not prove that leprosy had

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been endemic in biblical-era Palestine before the first century ce nor does it give any indication which diseases were included in the term sara’at. For the time being these questions remain unanswered. The height of the European outbreak, assumed to have occurred between the eleventh and the thirteenth centuries, is at times referred to as an “epidemic,” meaning the occurrence of more cases than would be expected in a region during a specific time period. There is no data available on the actual number of leprosy sufferers, but circumstantial evidence from a variety of disciplines indicates that during that period, Europeans were strongly preoccupied with clinical leprosy. We also know that the era coincided with crusader troop movements and expansion of mercantile traffic with the Levant, and was therefore a period when European medicine was most influenced by Middle Eastern medical texts. At the beginning of the second millennium, texts translated from Arabic into Latin provided a major breakthrough in the understanding of leprosy. By the eleventh century, treatises on the systematic study of medicine finally reappeared in parts of Europe, while “most of the continent was still in the dark ages.”22 The founding of the medical centers in Salerno, Italy, during the eleventh century and in Montpellier, France, one hundred years later laid the foundation for better-trained physicians. All these developments supplied the population with a better understanding of medicine. Avicenna (980–1037), for example, divided leprosy into four distinct categories, and Bernard Gorden’s Lillium medicine (1283) organizes the illness by four humors and temperaments and cites them as leonine (choler), alopecia (sanguine), elephantia (melancholia), and Tyria (phlegem). This more intricate division does not necessarily reflect a greater knowledge of the many possible symptoms of Hansen’s disease, and to my knowledge, artists never attempted to specifically portray the four individual humors in leprosy patients.23 Since undoubtedly few of the Bibles were produced with the help of learned physicians, medieval artists rendered most leprosy victims quite schematically—simply to indicate the biblical affliction.

Leprosy during the Early Modern Era With the dawn of the modern era, European secular physicians gained a better understanding of communicable diseases. Renaissance doctors, familiar again with the discoveries of the ancients, composed

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medical treatises that emphasized the possibility of an infection spreading through the air. They published checklists for medical practitioners to consult, dividing the manifestations into predisposition (a state that could downgrade to leprosy), univocal signs (specific to leprosy, not seen in other illnesses), and equivocal signs (also seen in other diseases). Symptoms most often recorded as univocal included roundness of eyes and a fixed stare, thickening of the flesh above the eyebrows, loss of facial hair, widening of nostrils, deformed lips, hoarseness, fetid breath, and body odor. Manifestations also found in other illnesses (equivocal signs) were tuberous flesh of joints, ulceration, and anesthesia in extremities. Demaitre’s list is shortened considerably, limiting the signs to those applicable for the study of the visual arts.24 Some manifestations can be readily detected in the clinical photographs shown in chapter 1, especially figures 1.2 and 1.3 (pp. 11, 13). The year 1347 represents a watershed in the history of contagious illnesses when the second pandemic of bubonic plague, also known as the Black Death, changed medieval Europe forever. The two diseases, HD and bubonic plague, had little in common, and leprosy lost its status as the most disastrous sickness known. While leprosy made people suffer for many years but affected only a few, bubonic plague killed quickly and indiscriminately; an estimated third of Europe’s population perished before 1353. There were, however, positive consequences of this cataclysmic plague pandemic, including new medical knowledge, a better understanding of infections and rudimentary epidemiology, improved diagnostic skills, restructuring of the public health system, and appreciation of practical experience. The advances were spearheaded by papal physician Guy de Chauliac (1300–68), who raised medical science to a new level, particularly in the regions around the court in Avignon and the progressive medical school of Montpellier where Chauliac taught.25 This newly gained scientific knowledge also affected victims of leprosy. In the fourteenth century, novel dress codes for people stricken with leprosy were developed, not so much to ostracize the sick, but in the hope of protecting the healthy. Leprosy edicts show a significant affinity between medicine and religious requirements. These edicts were read to the afflicted as part of the religious separation ritual (see appendix): “I forbid you to leave your house unless dressed in your recognizable garb and also shod” [emphasis added].26 The importance of wearing

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shoes is noteworthy; unfortunately the edicts do not explain why shoes were an essential part of the outfit designed for leprocy patients. Portraying the sick no longer as going barefoot with “rent clothes” was a conscious change from the Levitical text, as was the demand that the sick cover their heads. Those sufferers diagnosed with the dreaded ailment were required to wear long garments with sleeves in order to limit the contact with exposed skin blemishes; modern science has not excluded skin-to-skin contact as a method of transmitting leprosy from person to person. Many artworks from different parts of Europe show regional differences in style or robes of different lay fraternities of leprosy patients (and sometimes also of caretakers). Also, the leprous were not allowed to have any contact with healthy persons or drink from public fountains for fear they might poison the water. They were required to wear gloves in case they wanted to touch the rim or the rope of a well. The afflicted were also forbidden to touch food in stores with bare hands; it may be that wearing shoes was also intended as a protective measure against spreading contagion.27 Moreover, the infected were provided with special receptacles—cups, flasks, or kegs—in which all purchases as well as alms, whether money, food, or drinks, had to be deposited. The next centuries brought some advances in the medical sciences, and at the same time there was a decline in the incidence of leprosy in central Europe; however, modern scholars have not established that these two events are related. In the fifteenth century, as Western art became increasingly lifelike, the depiction of leprosy victims kept up with the artistic trends. The interest in realistic descriptions of physical ailments of all kinds, including leprosy, culminated around 1500 when clinical realism and the strong desire to record science briefly converged with the artistic quest for imitating nature. English physician Keith Manchester and archaeologist Christopher Knüsel describe a late fifteenth-centurty sculpture depicting the parable of Lazarus and the rich man (Luke 16:10–26) as “one of the most significant, clinically accurate, and best preserved objects in the art history of leprosy.” The biblical beggar Lazarus is recognizable by his clapper (fig. 2.8).28 The authors diagnosed the disease by describing the manifestations in modern medical terms: The facial nodules represent lepromas, and the lower eyelid deformity is indicative of lagophthalmos [inability to close the eye]. The nasal deformity and the depression of the infranasal zone are

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Fig. 2.8  Lazarus and Dives, detail of cloister column of Abbey of Cadouin, France. (Photograph by Luke Demaitre, 2005. Used with permission.)

compatible with facies leprosa and an underlying rhinomaxillary bone syndrome. The clawed toes indicate extensor muscle paralysis consequent upon lepros motor neuropathy. The swollen foot is suggestive of deep tissue sepsis, and the bandage probably indicates ulceration and ascending infection into the lower leg. Thus Lazarus is portrayed as a man suffering from advanced lepromatous or near lepromatous leprosy.29

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Lazarus’s head displays undoubtedly accurately placed physical manifestations of Hansen’s disease, giving testimony to improved empirical knowledge acquired by both the physicians and the sculptor. The figure most likely represents a pathognomonic composite, showing signs of a specific illness (in this case of lepromatous leprosy), but not intended as a portrait of a specific individual.30 It is noteworthy that the positioning of the leproma on the ridge of the victim’s nose can be compared with the placement of the nodule on the Carolingian relief (fig. 2.5) centuries earlier; both portray a man suffering from lepromatous leprosy. The sculptors had the advantage that modeling produced more realistic facial lepromas that could be readily identified as the symptoms of HD. In contrast, the creator of the Ottonian manuscript painting Christ Healing a Leper (fig. 2.6) had the more difficult task of conveying an equally convincing spatial effect on parchment. For this very reason, the artist(s) chose to emphasize hair loss, which was quite easy to render and would be instantly recognized—provided the viewer was familiar with the symptoms. Comparing the sculpted Lazarus head to the photograph of a patient with lepromatous leprosy (fig. 2.9), it is immediately clear that the sculpture was not based on a drawing of a live model. Although the essential groupings of the lepromas are correct, the nodules are simplified, and the surfaces are smooth compared to the lepromas caught on camera. Even though the confluent facial lepromas are stylized, we accept the appearance of Lazarus’s face as naturalistic and acknowledge the positioning of all of the nodules in their correct places on the head (brow, the ridge of the nose, the lips, chin, etc.).31 These cursory comparisons of various periods and media confirm that recognition of familiar religious subjects helped establish the artist’s intent to portray leprosy. The fascinating drawing Head of a Young Man (fig. 2.10) lacks such a textual identification. Attributed to Hans Holbein the Younger, the portrait comes close in its precision to a photograph,32 yet artistic realism does not solve diagnostic problems. Over the years, the facial nodules must have been scrutinized. At one time, the drawing was dubbed Jeune Lépreux; this caption has since been removed, presumably because no diagnostic consensus could be reached.33 The two sculptures, the painting, and the drawing analyzed in this chapter were created in different periods, and certainly lack the precision and objectivity of a camera, yet even some of the most primitive

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Fig. 2.9  Head of Lazarus, detail of fig 2.8, Lazarus and Dives, Abbey of Cadouin, France. (Photograph by Luke Demaitre, 2005. Used with permission.)

Comparison with Patient with Lepromatous Leprosy. (Photograph by Frank R. Keefer, 1899, courtesy of National Library of Medicine, Bethesda, MD.)

historical illustrations could supplement information found in ancient treatises. Evidently, ninth-century physicians studied leprosy as an illness that attacked the whole body; they did not rely solely on dermatological examinations. Most surprising, these empirical findings were recorded in art, possibly to make the scenes more believable. The works analyzed in this chapter shed light on the slow progress that premodern and early modern medicine made in fighting a disease for which they had no cure. The art objects indicate that some doctors or medical practitioners must have been aware of the disfigured faces and bodies of leprosy victims, and of their battles with paralysis, receding hairlines, ulcerations, and loss of voice, to name frequently depicted manifestations. Close study of the visual primary documents, such as the Carolingian relief and the Ottonian book illumination (figs. 2.4–2.7) provide evidence that, beginning with the ninth century, clinical leprosy must have been equated with the term lepra in the New Testament.

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Fig. 2.10  Hans Holbein the Younger, Head of a Young Man, 1523. Drawing. (Harvard Art Museum, Fogg Art Museum, Bequest of Paul J. Sachs, “A Testimony to my friend Felix M. Warburg.” 1949.2. Photograph by Allen Macintyre © President and Fellows of Harvard College.)

Without a doubt, the depiction of biblical characters carrying horns and canes indicated to viewers that the ailment associated with Christ’s miracles was the horrific illness they encountered in their daily lives and called lepra or elephantiasis, even though neither medical treatises of the ninth to eleventh centuries nor the New Testament mentions those specific attributes. By the fourteenth and especially the fifteenth

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century, however, medical literature gave more intricate descriptions of the manifestations of HD, and these additional details are certainly evident in the Lazarus sculpture (see fig. 2.8), demonstrating how medical texts and increasingly accurate observations from life changed artistic perceptions of how to depict the illness. Manchester and Knüsel’s detailed description of Lazarus’s symptoms notes signs such as changes around the eyes, the deformation of the nose, mouth, and forehead, and the ulcers on lower extremities, which were typically absent in artworks from earlier periods. Admittedly, informative images of leprosy sufferers were rare and were generally produced around centers dedicated to the study of medicine; it is difficult to find many additional sculptures and paintings that indicate detailed knowledge of the medical signs of lepra/elephantiasis. The vast majority of historic images show stylized depictions of the symptoms for the sole purpose of making the religious narratives easy to read. The review of medical knowledge of the time helps establish a time frame in which innovations appeared in the visual arts, and helps to debunk the myth that real-life victims of Hansen’s disease were recognized exclusively by their “diseased skin” and that dot-like skin rashes covered their whole bodies, as seen in some medieval images. The clinical markers on leprosy patients will be examined further in the chapter on iconography.

Chapter 3

Societal Responses to Leprosy in Europe Hansen’s disease seems to have been on the rise in Europe during the ninth century, peaking most likely around the twelfth or thirteenth century and slowly declining in the fourteenth. In some regions, clinical leprosy remained a noticeable presence until the twentieth century. The present discussion focuses on leprosy-related events that, when they occurred, caused varying reactions by different groups and institutions—the church, civil governments, or various communities. One objective of this study is to examine how victims of the disease were treated and how they were represented in the visual arts. In order to do this, one has to delve into the ideological background that elucidates why the leprous population was set apart from patients with other illnesses. The history of leprosy during the Middle Ages presents interesting contradictions. After examining the extensive literature produced for the guidance of confessors and penitents that stressed the virtues of charity and humility in gaining paradise, Carole Rawcliffe summarized the situation quite appropriately: “Lepers occupied a highly charged and profoundly ambiguous position in medieval society.”1 A paradoxical perception of leprosy victims remained strong for centuries. On the one hand, the patients were considered outcasts; because the church linked disease with sin, leprosy victims were shunned. On the other hand, they occupied a very special place in the religious community, as they offered the wealthy an opportunity to practice charity by supporting the downtrodden. The inmates of leprosaria in turn contributed to the community through their prayers of intercession. Countless saintly men and women devoted themselves to the care of the leprous, kissing their feet and providing basic health care for them. History records many members of the English, French, German, and Hungarian nobility who were canonized as saints for their selfless dedication to caring for the leprous population. In the Middle Ages, theology and medicine were closely 45

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intertwined. For the most part, physicians practiced medicine to the best of their abilities without considering the moral character of their patients. Despite being sworn to uphold the classical oath of “doing no harm,” they were also firmly entrenched in the Christian tradition. Guy de Chauliac, for example, gave his physicians written instructions on how to comfort leprosy victims during the diagnosis, noting that this illness is the salvation and purgatory of their souls, “and if the world loathes them, God, who loved the leprous Lazarus more than others, does not.”2 Segregation of infected persons may have originally reflected the laws of Leviticus, but it also indicated an awareness of infectious diseases that dates back to the Roman period. As early as the fourth century ce— possibly even sooner—leprous patients were expelled from their communities in the Eastern Roman Empire under Constantine I. Over the centuries, the sick were stigmatized and occasionally viciously persecuted; however, in medieval Europe the isolation of the leprosy patients was often not vigorously enforced. From a modern perspective, violating strict isolation policies is a major infraction, but when compared to the strictness with which quarantine laws were policed during an epidemic of bubonic plague, it becomes apparent that authorities were much less concerned about leprosy cases, since the number of patients involved was comparatively small. To understand these discrepancies, one must also consider the state of medical science then and now. Experience had taught the medieval population that the transfer of leprosy to others was not immediate or even certain. The long incubation periods and a high percentage of immunity against M. leprae gave the public and possibly even the medical practitioners a false sense of security.3 No doubt people frequently reacted to leprosy victims with disgust and fear. Countless leprosy trials attest to the fact that individuals were accused of being infected. Clerics and secular members of society conducted leprosy trials; representatives of the medical profession remained conspicuously absent until the fourteenth century. At times, courts justly vindicated individuals; but others may have been mistakenly confined to leprosaria or otherwise isolated, losing freedom, family, and social position, as well as their property and the right to any future inheritances. Many leprosaria emulated the mendicant orders; the inmates had to give up all worldly possessions and begging became part of their way of life. Unjust as such procedures might seem by modern standards,

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they were not necessarily meant to denigrate the sick, but rather to prepare them for eternal life. It is natural that in the early Middle Ages, clergy would have been involved in diagnosing leprosy and in dealing with the infected. In the Mosaic tradition, priests judged illnesses and diagnosed leprosy, and in the Middle Ages, monastic libraries were the major repositories of knowledge, including medical knowledge, and many monks studied medicine. Because leprosy was incurable and usually fatal, care of infected people focused on preparing them for death and the afterlife, as well as isolating them to prevent the spread of the disease. There were probably some cases of misdiagnosis, but over the centuries, diagnostic methods improved and produced verdicts that were as precise as one could possibly expect at the time.4 Unfortunately, it is impossible to estimate the number of people infected with leprosy in medieval Europe. Since we lack data to quantify the extent of the illness, historians have looked for evidence in the ambitious projects of building leprosaria. One of the earliest documented European leprosy hospitals adjoined St. Gall’s monastery in modern Switzerland. It was built around 830 ce, just before the appearance of the first Carolingian artworks depicting leprosy. However, most lazar houses were founded in the eleventh century, even before the Third Lateran Council (1179) required that the sick had to be placed into institutions. Thousands of lazar houses appear to have been built throughout Europe. Best documented is the situation in England, where over three hundred leprosaria were founded before 1350. Whether the large number of new shelters for leprosy patients really reflected the spread of leprosy or if changes in church policies were the reason for the building boom is now a much-debated issue, but it seems plausible that a number of factors contributed to this expansion in leprosaria. Still, once the movement for founding leprosaria began, it clearly gained a momentum of its own,5 although it is not possible to be sure of the patrons’ intentions in constructing these hospitals and whether inmates were sheltered or unjustly imprisoned. Recent research on bones found in leprosy cemeteries, however, confirms that diagnoses were generally more accurate than was previously assumed. Whether medieval attempts to curb the spread of infection by building leprosaria was futile or whether it de facto made some impact cannot be firmly established; however, because leprosy was an incurable infectious illness, isolation seemed to be the only available recourse.

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Significantly, the assumption by some modern historians that all the precautionary measures were merely the result of ill will on the part of the medieval population can no longer be sustained and a justifiable fear of becoming infected must be acknowledged.6 On the other hand, whether church officials saw the crisis primarily as a dangerous moral corruption rather than as a health issue is a different issue and unanswerable. Rulings of the Third Lateran Council (1179) enforced separation according to Mosaic law. In order not to deny the inmates a Christian life, lazar houses were required to provide their own chapel, graveyards, and attending priests. Even prior to the twelfth century, there was already a long tradition of similar directives on religious practices and provisions for the sick. In 726, Pope Gregory II advised Boniface, an Anglo-Saxon missionary (later canonized), “that ‘lepers’ who belong to the Christian faith should be allowed to partake of the body and blood of the Lord, but they may not attend sacred functions with people of good health” [emphasis added].7 To cite a less sympathetic reaction to the diseased, when Pope Alexander III (1159–81) learned that Baldwin IV, crusader king of Jerusalem, suffered from leprosy he questioned his ability to rule, stating that Baldwin was “severely afflicted by the just judgment of God.” It is interesting that a Muslim source, the biographer of Saladin, Sultan of Egypt (1138–93), also expressed surprise that the Frankish king remained in office.8 Lateran III declared the afflicted as already “deceased,” and prescribed a religious ritual, the Separatio Leprosorium, during which the Office of the Dead was read over the patient. Provisions for lepers to celebrate mass would indicate that they embraced a world of spirituality. On the other hand, theoretically, such a person would never again be allowed to visit a parish church or participate in community activities, but theologian Fr. Martinus Cawley compared the wording of the ritual with some of the rites read to novices when entering a nunnery or monastery and stated that the church “honored the lepers as her wards something akin to the biblical Nazirites (Num. 6:8–21).”9 The Fourth Lateran Council (1215) under Innocent III (1198–1216) brought further restrictions to patients diagnosed with leprosy. The required special attire seems to express an anxiety about the disease. Already in the Ottonian period leprous persons were identifiable by the carrying of horns (see fig. 2.6, p. 34), but the edict of 1215 also required Jews and Muslims to wear distinguishing clothing, which cannot be explained merely by

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concerns for physical health. This indicates that moral issues were the primary criteria for ordinances directed against people living outside the Christian faith and “lepers,” who some considered malignant members of society.10 Attitudes, however, changed over the centuries and also within regions. Marcia Kupfer remarked that in France, “The transition away from a more compassionate regard [toward the leprous] began to set in around Lateran III which produced legislation governing the establishment of leprosaria and quickened toward rejection and revilement after Lateran IV.”11 Tragically, a century later, the fate of people with leprosy took a catastrophic turn. Tolerance toward the afflicted was on the decline, especially in France and some of the surrounding countries, but excesses of abusing “others” culminated in 1321 when “lepers,” “Jews,” and other “heretics” were demonized and accused of conspiring to infect the rest of the population with leprosy. The spurious plot caused the gruesome death of countless innocent people who were either burnt to death or buried alive. Pope Benedict XII (1334–42) confessed in 1338 to having participated in the fabricated lepers’ plot while in the service of Pope John XXII (1316–34).12 As far as I am aware, none of these events is illustrated in a chronicle, nor are there contemporary pictures of this legendary plot. It was not only the leprosy patients who were stigmatized and viciously persecuted. Raymond Mentzer brought to my attention another heinous chapter of European history, the fate of the cagots of Béarn, a minority group of unknown ethnicity and traceable to the early thirteenth century. They were also referred to as Gésitains, which was thought to derive from the Old Testament name “Gehazi” (see 2 Kings 5:27. Labeled as carriers of the curse of leprosy, the cagots were treated as if they were indeed afflicted with that illness. They had to wear the garb of the leprous and were not allowed to go barefoot because they were suspected by association of being a danger to the community. Segregated in church and entering only through a special low doorway, they were also served a separate chalice. These unfortunates, segregated into their own quarters in cities or in villages, were excluded from farming and made to fulfill all onerous tasks dealing with death, similarly to the “untouchables” of India. Thousands of them eventually appealed to the highest authorities, including Pope Leo X (1514), Emperor Charles V (1524), the parliament of Toulouse (1629), even to King Louis XIV

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(1683), who generally heard their pleas with sympathetic ears, but all their efforts were in vain. Even after doctors certified them to be healthy, cagots remained victims of the biblical leprophobia. It was not until the French Revolution in 1789 that the cagots finally regained their full political and social rights.13 Whether these incidents affected the building of lazar houses is difficult to assess. Since the creation of leprosaria is not a reliable indicator of the number of the infected, scholars have searched other sources to gain a more realistic picture of the situation; additional evidence may be gathered from chronicles, biographies, hagiographic accounts, canonization dates, and even creative literature. Three vitae of famous personalities whose leprous state is uncontested provide some information about their life at the height of the epidemic. The political career of Baldwin IV (1160–1185), king of Jerusalem, is outlined in three independent contemporary sources. Throughout his life, Baldwin fought a fierce battle to retain the Crusader Kingdom and the city of Jerusalem where he was born. Although the prince showed early signs of leprosy, he was not definitively diagnosed until after he had been crowned king of Jerusalem at the age of thirteen. According to Marcombe, “Leprosy might have played a greater role in Middle Eastern daily life than in the Latin West.”14 Still, Baldwin led his troops into battle until a few years before his death; because of his paralyzed right hand, he used his left arm to swing his sword, and he had to control his steed entirely with his knees. Despite the king’s physical handicaps, he was an effective ruler. Three years before Baldwin’s death, he lost his eyesight and had to be carried in a litter. Despite this, he reigned even from his deathbed, when he elected his young nephew as co-king. Baldwin was not quite twenty-five years old when he died in 1185. Medical historian Piers D. Mitchell, in an appendix to Bernard Hamilton’s ἀ e Leper King and His Heirs, describes the course of the king’s disease based in part on information from contemporary sources. He states that the anesthesia in hand and arm that Baldwin experienced as a child was most likely borderline tuberculoid leprosy and suggests that over time it could have downgraded to the lepromatous form. Baldwin’s face and hands were deformed and covered with ulcers, yet the specific cause of death was never established. Two years before his death the king had fever attacks.15 A similarly rapid progression can be observed in the photographs of the young Hawaiian patient in figures 1.1 and 1.2 (p. 11).

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Similarly, Henry VII the Lame had only reached the age of thirtyone when he died (possibly by suicide) in 1242. In contrast to the very public life led by Baldwin IV, Henry, who was born after the church’s new requirements had gone into effect, ended his days in secrecy. The oldest son of Emperor Frederick II, Henry was born in Sicily in 1211 and crowned king of Germany at the age of eleven. Although constantly engaged in diplomatic missions and wars, he was not always an obedient son to his father, who dethroned him in 1235. From then until his death, it seems that Henry was kept prisoner in various places in southern Italy. Historians have tried to clarify whether this imprisonment was “incarceration” or “isolation.” This question was resolved in 1999 when a team of Italian experts examined his skeletal remains and established that Henry VII had suffered from advanced lepromatous leprosy. Frederick II buried his firstborn with great honors; his disease, however, remained a secret until about a decade ago.16 Compared to the fairly active lives the two young kings led, Lady Alice of Schaerbeek (ca. 1220–50), a Cistercian nun revered by that order, pursued a contemplative life and must have been diagnosed with leprosy only after she turned eighteen, when she was already in vows. She ended her years in the convent of La Cambre with her blood sister and a maid as her attendants, in a special hut apart from the other nuns. In her painful last decade, Alice continued to participate in the liturgical and intercessory life as best she could. She confided to her sister Ida that she was not suffering from “sins of her own” but rather for the sins of the world. Her vita is recorded in several Latin documents, which Fr. Martinus Cawley recently studied and translated.17 Even though her posthumous biography was not intended as a medical account, it confirms the characteristic stages of lepromatous leprosy. Particularly instructive is the description of Lady Alice’s deteriorating body and her slow, painful decline. It is said that Alice, however, never lost her speech and was mentally alert until she fell into a coma about two hours before she died on Saturday, June 11, 1250. It is not known whether her unidentified biographer had met Lady Alice, but he probably at least knew witnesses who described how her hands were affected and how her fissured skin was marred with multiple pussy wounds. Alice, too, lost her eyesight.18 Clinical photographs (see figs. 1.2, p. 11; 1.3, p. 13) confirm that the author’s description was by no means an exaggeration of Lady Alice’s debilitated state. A more coherent picture of the stages of Hansen’s disease

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evolves when we summarize some of the data on these three individuals. Baldwin’s biographer, William of Tyre, mentioned the absence of sensitivity in one arm as the first indication of leprosy in his princely ward, and Henry VII was known to be lame. Before their deaths, both Lady Alice and Baldwin were documented as having experienced less than ten years of decline that ended in blindness and an inability to move. What seems remarkable is that none of the three appeared to have suffered any loss of their mental faculties. For many years, all three communicated with their attendants and executed their duties, albeit in diminished capacity. The only fairly reliable case history of a leprosy patient before modern drug use changed the stages of the illness derives from Fr. Damien of Molokai in the nineteenth century. He nursed the afflicted in his Hawaiian colony for about eleven years before he noticed in 1884 that he had become insensitive to scalding water. He died about five years later, whispering his last instructions (because his voice had suffered) for the future of his wards just before his death on April 15, 1889. During the short final phase of his HD, Fr. Damien became bedridden and had poor eyesight, but again, the friar was apparently in full command of his mental faculties, which would confirm the authenticity of the biographies written centuries earlier. The individual biographies make us aware of how much the scourge influenced the victims’ fates, but most importantly, these written documents show that in the Middle Ages leprosy was a disease not only of beggars but also of kings, pious ladies, and even high-ranking clerics.19 It is probable that since members of the elite were infected, a proportionate number of their less well-known contemporaries must have been sick with leprosy as well. Just as the most famous persons infected with leprosy—Baldwin, Henry VII, and Alice—lived in the twelfth and thirteenth centuries, the same is true of saints who ministered to victims of leprosy. Of these, the most popular saints are SS. Francis of Assisi (1181/2–1226), Elizabeth of Hungary/Thuringia (1207–31), and Louis IX, king of France (1214–70). Even earlier legends, such as those of St. Martin of Tours (d. 397) and St. Benedict (c. 480–c. 550), were sometimes updated to include episodes showing service with “leprous” beggars. Finally, the earliest prominent literary works involving leprosy topics date to approximately the same time as the historical narratives discussed above. The Latin poem Amicus and Amelius became known in the eleventh or twelfth century; Tristan and Isolde and von der Aue’s Poor Henry [Der arme Heinrich] were

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both created at the end of the twelfth century.20 While these facts cannot be considered hard scientific or medical evidence, they do support the supposition that the height of the European leprosy epidemic did indeed occur during the eleventh through the thirteenth centuries. The question of whether medical considerations may have played a role in changing sacramental rituals has, to my knowledge, not been previously raised. According to Miri Rubin, the process of denying the lay community communion sub utraque specie (under both kinds: bread and wine) began in the twelfth century. Over the years and for a number of reasons, large communion chalices became a thing of the past; the sacred vessels with consecrated wine were withdrawn from all but the priests at the altar. However, Rubin points out that, “the removal of the chalice was not universal. In fact, only at the Council of Constance of 1415 was the reception of the chalice by the laity forbidden, and those priests who offered it to the laity excommunicated.”21 But as early as the twelfth century, Abbot Suger’s famous chalice (the mounting was fashioned 1137–1140) was already used with individual liturgical straws.22 This alteration may indicate that some concerns about infectious diseases occupied the theologians’ minds, although these ideas were never officially discussed. We know, however, that these novel trends generally affected the leprous population first. The description of Lady Alice’s illness may have served primarily as the framework for an inspired clerical exposé when her hagiographer wrote how the nun suffered after she was forbidden to partake of the wine during mass, until she had a divine revelation: Oh most loving daughter, do not be disturbed. Cease complaining as if something had been withdrawn from you. Firm faith calls for any who have tasted of my Body to rejoice in the belief beyond doubt that they are also being refreshed with my Blood. Since where the part is, there also is the whole. Nor should it even be called a part; it must rather be considered simply the whole. [emphasis added]23

This text repeats the twelfth-century theological arguments on concomitance, the idea that after consecration of bread and wine Christ’s body was fully present, thus justifying communion of one kind for the lay public. The concept of Christ’s body and blood being present in the eucharistic wafer anticipated the later teachings of the Council of Trent

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Fig. 3.1  Aureliano Milani, St. Aloysius of Gonzaga (?) Administering the Viaticum to a Plague Victim, first quarter 18th century, oil on canvas. (Image courtesy of Kunsthistorisches Museum, Vienna.)

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(1545–1564), when the format of communion for the laity again became an issue. The controversy between Protestant rites of communion of bread and wine and the Catholic version for laypersons of bread alone (until Vatican II, 1962–65) inspired countless plague paintings. Such altarpieces show generally a priest or saint, disregarding the danger to their own lives by bringing the last communion to the sick and dying. An imposing Tridentine document is the large painting St. Aloysius of Gonzaga (?) Administering the Viaticum to Plague Victims (fig. 3.1), which depicts the saint taking the eucharistic wafer from a chalice-like vessel, while the altar boy holds a paten-like plate for the recipient (so no crumb could be accidentally lost). The two liturgical objects symbolize the duality within the whole, contained completely in every morsel of the communion wafer.24

Medical Information Gleaned from Images of Leprosy Physicians of the premodern era had various methods for diagnosing leprosy, many focused on examination of blemishes on the skin. Other aspects of this complex disease needed to be considered as well. It is remarkable that long before the physicians could do microscopic research, they were aware that leprosy presented multiple and seemingly unrelated manifestations, such as anesthesia and paralysis in hands and feet (see the crutch in fig. 2.4, p. 32), loss of voice and loss of hair (fig. 2.7, p. 36), and lower leg infections (fig. 2.8, p. 40). All these afflictions were portrayed in the visual arts. One of the earliest depictions of a diagnostic topic appears in the ca. 1250 Anglo-Norman Chirurgia of Roger Frugard, which shows a practitioner using a sharp instrument to pierce the facial blemishes of his patient to establish if the person had a “curable” illness. Thirteenthcentury physicians must have been aware that the leprosy nodules were not filled with liquids. If the nodules were solid, it could be leprosy, if the skin blemishes contained liquids, it meant good news for the patient.25 Similarly, a fourteenth-century French manuscript contains an illustration titled William of Tyre Discovers Baldwin IV’s First Symptoms of Leprosy. The original text of the manuscript dates back before the year 1200. The miniature reveals how some diagnostic routines were performed and that at least in the Middle East, nerve damage was acknowledged as a suspicious sign. The historiated initial “M” depicts two consecutive scenes (fig. 3.2).26 On the left, several barefooted street

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Fig. 3.2  William of Tyre Discovers Baldwin IV’s First Symptoms of Leprosy. 14th century, illuminated manuscript. Detail below. (Image © British Library Board, Yates Thompson 12, fol.152v.)

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urchins surround the well-dressed prince. The group’s leader and young Baldwin have their sleeves rolled up, exposing fairly realistic, irregular leprosy markers. The two boys wrestle to determine which of them could endure more pain (leprosy made them less sensitive). On the right, we see Baldwin’s tutor, chronicler, and later chancellor of the kingdom, examining the boy. The tonsured William of Tyre, dressed in a monastic robe, looks lovingly down on his ward’s head, pained to discover that Baldwin displays early symptoms of leprosy. His implied actions and emotions are remarkably well observed for art of the fourteenth century. William holds the boy’s arm; while distracting him, the tutor with one finger gently taps the prince’s anesthetized hand and arm. Because Baldwin is looking down, he seems to be unaware of the test. This incident must have taken place before Baldwin was thirteen when his disease was in fact confirmed. Eventually, the advances of the printing press made it possible to produce medical books in greater numbers, and it became increasingly common for the instructions to be written in the vernacular. Hans von Gersdorff ’s 1517 Feldbuch der Wundtartzney contained a woodcut that takes us into an examination room (fig. 3.3). Inspection of Leprous Patients is supplemented with explanatory inscriptions that obviously emphasized practical experience over medical theory. The verse printed above the image reveals the diagnosis: “The blood, urine, nodules, glands, and the examination of the limbs, as well as bad breath and all the other symptoms leave no doubt that the man is infected with leprosy.”27 By the fourteenth century, leprosy examinations involved several health officials rather than only priests and laymen. At least three of the four gentlemen surrounding the infirm are medical practitioners. They represent the health commission who had to investigate people accused of being infected with leprosy. The surgeon standing somewhat behind the seated patient palpates a lepromatous nodule on the balding forehead, most likely to establish the consistency of the skin protrusion. Another nodule is visible on his chest and another on his lower leg. The examiner turns his head as if to confer with his colleagues. He may, however, also be paying attention to the warnings in medical literature that doctors should protect themselves against the patient’s contagious breath: “Des athems gstank …” as the caption reads. Although this warning was mentioned repeatedly, the exact process of transmission was (and still is) unknown; however, the surgeon’s reaction was not unwarranted because

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Fig. 3.3  Inspection of Leprous Patients, woodcut in Hans von Gersdorff, Feldbuch der Wundartznei (Strasbourg: Johannes Schott, 1517), p. 67. (Image courtesy of National Library of Medicine, Bethesda, MD.)

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it is now known that lepromatous-type patients shed a large number of bacilli through their nasal mucus that might be inhaled through “mouth and nose,” as the Romans had already suspected. The physician on the right scrutinizes the contents of a urine flask—also called “Jordan” (this procedure is challenged by today’s scientists). Demaitre gives a thorough analysis of the scene, based not just on the visual evidence, but primarily on the research of Gersdorff ’s handbook and other medical texts on diagnosing leprosy. He established that the barber or barbersurgeon who dips a cloth into the bowl placed next to the patient is not preparing a bandage for the open sores of the lower leg, but testing the patient’s blood for characteristic residues (no longer practiced in modern medicine). The two small cups on the table would have contained salt and vinegar needed for this procedure.28 The stigma and consequences of being diagnosed with leprosy were severe; therefore, people generally tried to keep the telltale symptoms hidden as long as possible. It is interesting to note that in the 1517 print, the patient shows developmental stages similar to those of the twentieth-century inmate of a Hawaiian leprosarium shown in figure 1.1 (p. 11). When the thirteen-year-old was first admitted by medical authorities, the patient showed only a few nodules on his face and the thickening of his right ear. Although these two images are separated by more than four hundred years, the stage of the disease when the infected could no longer hide their misfortune remains roughly the same. Arabic medical books depict physicians cauterizing lepromatous nodules, a treatment advanced by Albucassis (936–1013) and Avicenna (980–1037), and also practiced in the West. St. Francis may have suffered from leprosy, since it is reported that his forehead was cauterized. The saint’s reported inability to feel pain, however, was interpreted by contemporary sources as a sign of sanctity. Modern scholars propose that this phenomenon was an indication that St. Francis had become infected while tending his leprous patients.29 Greater interest in the sciences, along with an increased veneration of intercessory saints, produced numerous depictions of therapy— or at least of the care leprosy patients received. Particularly in the region of the kingdom of Hungary (modern Hungary, Transylvania, and Slovakia), clinical leprosy must have been a noticeable presence. Livia Kölnei reported that she had found twenty-five cases of written evidence in that region dated to between 1082 and 1575 that mentioned the terms

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“leprosorium,” “domunculus leprosorum,” “Saint Lazarus Hospital,” “villa leprosorum,” or “puteus leprosorum.” No documents mentioning lepra can be found later than the end of the seventeenth century.30 Visual evidence of leprosy, particularly in the fifteenth century when realistically depicted leprous patients appear in art, can be studied in many hospital scenes, a popular subject for large altarpieces. Most frequently portrayed is St. Elizabeth of Hungary/Thüringia. Maria Vida, in her essay “Die Heilige Elisabeth und die Betreuung der Aussätzigen in den Legenden,” emphasizes the clinical information rendered in these artistic productions.31 These fifteenth-century paintings shed a great deal of light on medical history. Many of the Hungarian hospital scenes record innovative empirical observations frequently ignored in medical treatises. This unique scientific emphasis may be based on several factors, first and foremost the influence of the renowned King Matthew (Matthias Corvinus), who ruled Hungary from 1458 to 1490. He was a learned patron of the arts and sciences who amassed a famous library—the largest secular collection of manuscripts in fifteenth-century Europe—that benefited the public health system and educational opportunities of his subjects. Cultural exchanges between his kingdom and the Middle East, and possibly even retention of Roman traditions in the former province of Pannonia, made his domain a progressive state. Since antiquity, therapy in general was often restricted to providing basic hygiene, tending open wounds, and serving a good diet. Bloodletting, measuring the pulse, and purging, as well as baths in hot water or in mineral spring water, were also staples in ancient medicine. Over the centuries, physicians had to admit that, other than by supernatural powers, there was no cure for patients with confirmed leprosy. They only recommended medical treatment in the early stages; later, they provided palliative care. One has to credit surgeons of earlier centuries for not attempting to operate on the patients’ modules, which are filled with M. leprae. Some physicians may have tried cauterizing lepromas, but apparently with little success. In the fifteenth century, as in the Roman era, hygiene again became an important part of health care. One of the most revealing and pertinent scenes occurs in a panel of the high altar in the St. Elizabeth Cathedral, Košice, Slovakia. The church itself was, according to Vida, “closely aligned with a hospital,” although we do not know if that complex also included accommodations for leprosy patients. St. Elizabeth Bathes a Leprous Patient (fig. 3.4), dated 1474–77,

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Fig. 3.4  St. Elizabeth Bathes a Leprous Patient, 1470–77, painted panel. Detail of main altar, St. Elizabeth Cathedral, Košice, Slovakia. (Image courtesy of St. Elizabeth Cathedral, Košice, Slovakia.)

depicts a ward in a leprosarium where hygiene was an essential part in the therapeutic efforts (similar bathing procedures are still practiced in other parts of the world). The patient whom St. Elizabeth treats is covered with brown-red blisters; they appear on his face and arms, making the illness identifiable at first glance. The awkward pose seems to imply that the youth has contractions of the joints and limbs. A second patient—the figure in a cap seated in the left foreground— is also marked with signs of leprosy; he bides his time waiting to be cleansed. His left hand shows clawlike muscle atrophies; figure 1.5 (p. 16) shows a similar flexion deformity on a modern patient. His lagging eyelids and bandaged lower legs—leaving the knees exposed—as well as the crutch lying nearby, which indicates

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paralysis, and the skin blemishes indicate that he, like his compatriot, suffers from Hansen’s disease. Most of the patients depicted in the leprosarium appear to have juvenile bodies, although HD has aged their faces considerably. Until fairly recently, because infants were not separated at birth from an infected parent or wet nurse, people often contracted leprosy in childhood, as seen in Baldwin IV’s biography and the photograph of the young Hawaiian patient; in figures 1.1 and 1.2 (p. 11). The clippers lying on the stool in front of St. Elizabeth were most likely not surgical instruments, as some scholars have suggested, but were more likely used by the saint as she provided basic hygiene for her patients. In the Golden Legend, Voragine wrote that “she [St. Elizabeth] once took an ugly sick man … then cut his hair and washed his head, while the maids stood by laughing.” Soon, according to Maria Vida, this story was combined with a legend of an unknown woman who nursed leprosy victims. These didactic stories were first illustrated in fourteenth-century Hungarian murals and then in countless fifteenth-century altar paintings.32 The fifteenth-century Košice hospital scene is especially appropriate for the cover of this book because it shows how far European physicians had come in developing empirical diagnostic knowledge since the ninth century. By the fifteenth century, the increased number of diverse signs of Hansen’s disease known and depicted demonstrates that, centuries before the age of Pasteur, medical specialists were fully aware that these seemingly unrelated symptoms, ranging from dermatological signs to muscle and nerve damage were caused by a single illness that they knew as lepra or elephantiasis. Pilgrimages were also counted as therapeutic measures and were favored by patients suspected of having leprosy, and even by some whose illness had been confirmed. Leprous pilgrims were at times depicted visiting the shrines of medical saints. Pilgrims identified with St. Peregrinus (his name could indicate “stranger,” “pilgrim,” or “crusader”), who was said to have been a leprous pilgrim himself until Christ cured him in the church of St. Denis, outside of Paris (see pp. 119–20).33 Gentile da Fabriano painted a large Italian altarpiece, signed and dated 1425, not associated with a leprosy hospital, but painted for San Niccolo Oltr’Arno, Florence. Some of the altar’s panels from this masterpiece are now scattered throughout numerous museums. One of the predella images, ἀe Crippled and Sick Cured at the Tomb of St. Nicholas (fig. 3.5) portrays a

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Fig. 3.5  Gentile da Fabriano (ca. 1370–ca. 1427), ἀ e Crippled and the Sick Cured at the Tomb of St. Nicholas, 1425, painted panel. (Image courtesy of National Gallery of Art, Samuel H. Kress Collection.)

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miracle. In this image, crippled pilgrims, some carried by compassionate attendants, move toward the shrine, where all throng to get close to the sarcophagus. The high pillars that raise the sarcophagus enable the sick to come close enough to touch the tomb, for touching the object of veneration was considered very important in the healing process. On the left, a miraculously cured pilgrim returns home; formerly lame, he walks without the help of his two crutches, which he now carries casually over his shoulder. Clad in stylish leggings, he most likely did not suffer from leprosy; HD frequently manifested itself with open sores on the lower extremities, as seen on the man on the far right (fig. 3.5). In the latter figure, the blood-red wound on his lower leg is surrounded by several smaller clearly raised lepromas that resemble signs of clinical leprosy. This victim wears stockings that leave his ulcerated nodules exposed and he supports himself on a single crutch as he limps toward St. Nicholas’s shrine. The viewer is not privileged to see the outcome of his pilgrimage; most likely his chances of being healed are slim.34 None of these religious paintings I have examined shows negative responses to the victim(s). Instead, they depict an idealized world of saints and holy persons tending the sick. At times, even secular images addressed how society provided for leprosy patients. Although for centuries the church was instrumental in providing some care, the financial burden frequently fell on the gentry and later also on the bourgeoisie. In some regions, individual townships assumed liability for the spiritual and physical care of the inmates of lazar houses. For example, Nürnberg hosted a special annual celebration for its leprosy victims. During the fourteenth and fifteenth centuries, the city became a showcase for the medical profession and for the care of its citizens. Four leprosaria lay outside the city gates and the municipality even provided a hospital for the leprous, who were allowed to spend time within the city walls from Tuesday to Friday of Easter week.35 This tradition began in 1394; one year the mayor refused to let the leprous people observe Holy Week, and it was said that his refusal triggered a plague epidemic. To show compassion and possibly to ward off God’s castigation in the future, the city of Nürnberg thenceforth showed special generosity to the afflicted suffering from leprosy, and by the 1490s the annual inspection turned into a grand celebration where the leprous poor were showered with gifts.36

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The 1493 Nürnberg broadsheet Annual Leprosy Inspection (fig. 2.2; p. 27) depicts such an event and documents, for all to see, the generosity of the burghers. The woodcut shows a group of patients in various stages of advanced leprosy during the religious holiday, when the sick were allowed to join the living and have their annual medical inspection. The sick show off a wagonload of warm blankets and clothing, and particularly the new shoes that they received from generous citizens. A number of rhymes accompany the different vignettes. Luke Demaitre points out an imposter pretending to be a victim of leprosy when, as the examining physician indicates, he does not belong in this group of truly ill persons!37 In the top left illustration, we see the fraudulent beggar is among the patients, turning away from the examiner. He wears his new shoes and carries a stick, and has his clapper and a purse hanging on his belt. This reversal—that the poor might fake some of the symptoms, rather than hide their affliction—can be explained by tough economic times at the end of the fifteenth century, when countless destitute tried to become wards of a town, identifiable by special clappers or bowls (their official licenses to beg). On the top right of Annual Leprosy Inspection, we see the infected attend a sermon in church. The minister on the pulpit addresses the group, saying “brother[s], be patient,” and the verse below the image encourages them to look to Christ as their model: Jesus who was completely innocent, accepted willingly his death, he suffered similar distress and fears. Therefore, thank him daily with all your heart and offer up to him your tortures and pains, so in turn, he will receive you mercifully. [my translation]

The text implies that in contrast to the victims seated in church, Christ who suffered his death for them had been without guilt (sin). The image in the center depicts the confessional scene discussed at the beginning of chapter 2, with the priest guarding himself against the contagious breath of his penitent. In the adjoining vignette, however, a leprous man receives the host in front of the altar, bareheaded, directly from the hands of the priest (compare with fig. 3.1). This close contact with the diseased emphasizes the clergy’s willingness to sacrifice their own health by ministering to the spiritual life of the needy.38 Later the group is seen feasting on fine foods at a large table; some of the afflicted have

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placed their crutches on the floor. One can only imagine how different this event must have been from their daily routine. E  E  E Several historical episodes indicate an intensified preoccupation with leprosy during the era of the crusades, manifested in building programs, increased interest in Eastern medical knowledge, the founding of nursing orders specifically for leprous crusaders, biographies of famous men and women, hagiographic accounts, adoption of Eastern saints, canonization dates, new church legislation, and more. Most significant and unique in Western history is the phenomenon that a small minority of disenfranchised leprosy patients exerted such a strong hold over the collective conscience of the general public. Was it fear of contagion, or moral indignation about the victims’ alleged sinfulness? One may never know. Although the threat of leprosy on the European continent seems to have diminished starting in the fourteenth century, artists continued to depict leprosy themes in the fine arts, and many of the most interesting artworks belong to the fifteenth, sixteenth, and even seventeenth centuries. The reasons for this are related less to the illness itself than to changes in the religious function of leprosy themes, medical and sociopolitical issues, and, above all, innovations in period styles. In the Latin West, the complex ideas presented in paintings depicting religious subjects are generally based on well-established texts. Consequently, in order to analyze the images, one must first explore the numerous biblical passages that mention lepra and the legends that surround most important saints of leprosy. A better understanding of the biblical and literary traditions of leprophobia, with all its implied controversies, helps one to understand how most people perceived the leprous population from the ninth to the eighteenth century.

Chapter 4

Development of Leprosy Iconography The methodology of art history requires an examination of an artwork’s iconography (image description). Iconography alludes to a thematic tradition and schemata of narrative imagery that are generally based on well-known textual sources. This chapter introduces the literary sources of leprosy subjects; many of these are biblical passages that mention lepra or sara’at, others include literature related to patron saints of leprosy. These stories molded the shared beliefs and moral attitudes of people during the period when leprosy was most prevalent in Europe. Because leprosy themes appear in the visual arts over a period of almost two millennia, artistic conventions, such as how a specific biblical episode was depicted, changed over time. Thus the study of iconography facilitates the dating of an artifact and serves as a prerequisite for deciphering the primary documents—the nonverbal images. Furthermore, iconography forms the basis for a scholarly interpretation of a work, generally referred to as the study of iconology (determining the meaning of the image), a term that alludes to the interpretation of an individual work that explains the symbolic meaning in religious and political terms, and places the art object in its cultural context.1 The theme of leprosy in the Latin West and its visualization in paintings, sculpture, murals, stained glass, book illuminations, and enamels, probably originated in early Christian catacomb decorations of the fourth century ce. After an apparent hiatus of nearly five hundred years, the subject reappeared and gained new momentum. Even though Latin Christendom refrained from illustrating most of the Old Testament leprosy topics, many intellectuals knew of Byzantine biblical images that could have influenced the West, whose art diverged from the Byzantine tradition and developed schemata that denoted the physical symptoms of the afflicted more realistically. Previous chapters explored medical facts as a tool to recognize leprosy in the visual arts. 67

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These clinical details, along with other leprosy signifiers or indicators (i.e., visual components of leprosy topics), help to determine which biblical or other literary sources were chosen for illustration in art.

Leprosy Signifiers Physical Manifestations, Attributes, Gestures, and Attire To assist viewers in identifying the subject matter of a specific work of art, various emblematic indicators of leprosy were established that changed comparatively little over the centuries. And although Hansen’s disease appears to be one of the first (if not the first) illness for which specific clinical signs were recorded, the distinctive skin blemishes (among very different manifestations) were generally abbreviated as dots or spots covering the entire body of the sick. In two-dimensional art forms, stylized markings of leprosy consisted of circles, comma-like lines, angles, and irregular designs that represented the lepromatous nodules on the victims’ faces and bodies. For painting, it is important to consider stylistic conventions and limitations of the medium itself that make it difficult to imitate nature; sculpture naturally presents threedimensional lepromas more realistically. By the fourteenth century, however, painters began to render various symptoms of the stricken in a more lifelike fashion, thus achieving greater realism. In the fifteenth century, artists introduced additional leprosy signs, depicting lower leg wounds, deformed joints, claw hands, distorted faces, bulbous noses, and round, staring eyes, among others. By that time, therefore, one can speak of a truly “clinical” iconography.2 However, well into the seventeenth century, some artists, along with portraying physical symptoms realistically, intentionally retained earlier conventions to aid in the identification process; these included the traditional dermatological signs usually indicated as dots or splotches on the face and on the victim’s body. Over the centuries, images recorded leprosy patients carrying horns, clappers, castanets, rattles, bells, and other sound-producing instruments; the specific sound instruments carried reflected the customs of a specific region and time period. Beginning with the ninth century, leprosy patients were commonly depicted carrying one staff, cane, or crutch, possibly to emphasize the distinction between the leprous and the lame, who usually supported themselves on two crutches. Although these artificial supports became early attributes associated

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with leprosy victims, images of crippled persons or the blind who did not suffer from Hansen’s disease also sometimes included them. Finally, the ubiquitous “leper’s cup” and flask/keg in which the unfortunates could receive purchases and donations completed the register of artistic indicators of leprosy. The clothing of the diseased merits special attention. From the ninth to the fourteenth century, victims of leprosy were characterized as shunned, ostracized, “ritually unclean” members of the community. Patients were depicted walking barefoot, wrapped in “rent clothes,” thus complying with the Levitical verse “The one who bears the sore of leprosy shall keep his garments rent and his head bare, and muffle his beard; he shall cry out, ‘Unclean, unclean!’ As long as there is a sore on him he shall declare himself unclean, since he is in fact unclean. He shall dwell apart, making his abode outside the camp” (Lev. 13:45–46). Despite their disheveled appearance, the sick were not necessarily characterized as poor. Later, when HD victims were isolated in lazar houses, they frequently took vows of poverty, chastity, and obedience. Thus, beginning in the fourteenth century, the stricken are depicted clad either in their lay-monastic robes, in institutional hospital clothes, or, when outside the leprosaria, in their “recognizable garb” that warned approaching persons. The locally prescribed attire, designed to expose the least amount of infected skin, included a hat, shoes, and above all, long, loose garments or pants; these were accompanied by their rattles and bowls, whether they were begging or not. In fact, most of these requirements regarding attire were part of the texts read to initiates at the ceremony of sequestration. An innovative example after the new health requirements went into effect, dated to the middle of the fourteenth century, illustrates Josaphat as a Ch ild Meets a Leper and a Cripple (fig. 4.1) based on the twelfth-century text of Miroir historial by Vincent de Beauvais. Josaphat was said to be the son of an Indian king. Since it had been foretold that Josaphat would not succeed him to the throne, the king sheltered his son from birth against any unpleasantness, such as sickness and death. One day the prince escaped his tutors and saw a leprous and a blind beggar. As a result of this experience, Josaphat secretly sought instruction in the Christian faith. According to the Golden Legend, Josaphat defied his family to become a hermit and later achieved sainthood.3

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Fig. 4.1  Josaphat Meets a Leper and a Cripple at the Gate of Jerusalem. Detail from Vincent Beauvais, Miroir Historial, fol. 373, book illumination. (Image courtesy of Bibliothèque nationale de France.)

This image depicts the prince taking his first peek through the city gate of Jerusalem at the real world outside his gilded cage. Two beggars, one a crippled and one a leper, approach Josaphat. The face of the leprous person is contorted and marred by countless skin eruptions; he is fully dressed and wearing a broad brimmed hat. The man holds his rattle in the right hand and his cup in the left. In contrast, the crippled beggar supports himself on two crutches and, significantly, because he is not deemed contagious, the lame man limps with bare feet and wears only a short tunic. It is possible that the images of the infirm wearing recognizable garb and being shod, reflected in the fourteenth century less the actual state of affairs than an acknowledgment of church ordinances;4 however, by the fifteenth century these requirements had most certainly become reality, as already seen in figure 2.2 (p. 27).

Literary Sources and the Visual Tradition of History Paintings A “history painting” signifies an image based on a specific narrative text, for example, on a Bible story or a saintly legend. Many of these religious works decorated churches, and for centuries, history paintings were considered to be the most prestigious commissions in the Latin West.

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This is a brief review of frequently depicted leprosy themes—based on biblical and hagiographical stories, which inspired European art. The Old Testament Scenes depicting leprosy, as previously discussed, were rarely illustrated outside the construct of scripture; the Old Testament provides central literary sources that describe sara’at or lepra at length. The various messages conveyed in the individual stories, however, hold essential information. First, in the recounting of Moses’s leprous hand and Naaman’s cure in the Jordan, the onset of leprosy or miraculous cures demonstrated the omnipotence of the Lord. Second, in the stories of the repentant Miriam, Gehazi stricken with leprosy, and King Uzziah’s punishment, leprosy indicated divine chastisement. Third, Leviticus 13 and 14 and Numbers 5 gave directions on how to diagnose sara’at (not necessarily identical to HD) and how to keep the population ritually clean. It is important to note the unique use of the term “white” in describing the victims when God struck Old Testament figures with lepra. Yet according to the evidence in Christian art, leprosy was generally symbolized by conventional dark dots rather than by whiteness.5 Although this book concentrates on the Latin West, the only culture that explored realistic illustrations of leprosy, some Byzantine examples will also be mentioned. There are six extant Byzantine Octateuchs (Septuagint version of the first eight books of the Old Testament) that date from circa 1070 to the end of the thirteenth century, and were made presumably for imperial patrons. Searches for visual prototypes— Hebrew as well as Christian—prior to the iconoclastic destructions (726–842) produced no solid signs of artistic antecedents. These Octateuchs contain illustrations that reflect primarily Christian ideals; most significantly, these illuminated manuscripts illustrated all five biblical leprosy stories contained in Exodus, Leviticus, and Numbers. Because their direct influences on Western art are at best minimal and in some cases controversial, this discussion is limited to describing the leprosy themes based on reproductions of these illustrations found in Kurt Weitzmann’s ἀ e Byzantine Octateuchs.6 The first of the leprosy stories is illustrated in the Octateuch Vatican 747 (Weitzmann, Byzantine Octateuchs, 614); it relates to the confirmation of Moses’s mission when God bestowed the power to engender miracles on the leader of the Hebrew people. Moses’s Hand Becomes

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Leprous “snow white” (leprosam instar nivis) depicts the miracle the Lord performs on Moses, demonstrating that God is all-powerful and can restore the health of the Hebrew leader at will (Exod. 4:1–8). The image depicts Moses raising his right arm, beneath the-powerful hand of God. The second leprosy story is depicted in Aaron Gives Directions Concerning a L eper, contained in Octateuch Vatican 747 (Weitzmann, Byzantine Octateuchs, 843). The folio presents the topic of God giving orders on how Moses and Aaron should handle cases of sara’at and how to diagnose a ritually unclean person. The two-tier division of the illustration directs our focus to the implied differences between the high priest’s position and that of the afflicted (Lev.13:38–39). Aaron presides in full regalia, next to the tabernacle in the upper zone. Below, in an empty field, the scantily dressed victim raises his hands pleadingly; simple dots cover his face and body, indicating his sickness. The third leprosy story occurs in the fourteenth chapter of Leviticus, which prescribes how a person cured of leprosy should fulfill the law (Lev. 14:1–32). Purification after Leprosy, found in Octateuch Vatican 747 (Weitzmann, Byzantine Octateuchs, 849), shows the formerly infected man, now without leprosy markers. He presents the two birds required for the ceremony, holding the already slaughtered bird (whose blood was intended for the cleansing ritual) in his hand; a live bird, to be released after the ceremony, rests in the meadow. Although Aaron now meets the former “leper” on equal footing, his facial features are not welcoming. Far in the distance the tabernacle is visible, still quite out of reach for the former patient, since he has yet to fulfill a number of other ritualistic requirements.7 An illumination in Octateuch Vatican 747 (Weitzmann, Byzantine Octateuchs, 879) depicts an additional leprosy subject, this one dealing with the dreaded affliction of God directing Moses to expel all lepers from their camp (Num. 5:2–4). Lepers Sent out of Camp portrays a nimbed Moses seated in front of a monumental sanctuary; he orders a young Israelite to conduct a group of infected members away from the community.8 The last leprosy story illustrated in the Octateuchs appears in Vatican 474 (Weitzmann, Byzantine Octateuchs, 912). Miriam Becomes Leprous tells the story of Miriam being struck with lepra for slandering Moses. The illustration depicts the two culprits, Aaron and Miriam, her face covered with dots, below the hand of God. Next to them, Moses prays to the

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Lord for a cure of his sister (Num. 12: 9–15). This story, the punishment of Miriam, is illustrated in numerous Bibles in Western Europe. Miriam is also an important figure in typological compendia, especially in the Biblia Pauperum.9 The most popular Old Testament subject in Western art is Naaman being healed of leprosy. The scene depicts the Syrian general’s conversion to Judaism after his miraculous cure by the Hebrew prophet Elisha in the Jordan (2 Kings 5:1–27). Most commonly depicted between the eleventh and the thirteenth centuries, the story enjoyed a brief revival during the Protestant Reformation, as Naaman’s story dealt with the idea of conversion to the true faith. In most instances, the general is represented when he has already been cleansed of his ailment. Naaman’s cure in the Jordan is frequently compared with the baptism of Christ. An excellent example of this topic is shown in Cornelius Engebrechtsz’s Naaman’s Cure in the Jordan, ca. 1524 (fig. 4.2). This story will be discussed in great detail in chapter 7.10 Apart from a few book illuminations, neither Eastern nor Western art depicted the prideful King Uzziah desecrating the temple with his unauthorized sacrifice at the altar of incense (2 Chron. 26:16–22). However, Flavius Josephus describes this story in some detail in his Antiquities of the Jews (see p. 151).11 The New Testament Art of the Latin West that depicts leprosy stories from New Testament favored the depiction of the Savior’s miraculous cures. Three out of the four gospels (Matthew 8:1–4; Mark 1:40–41; and Luke 5:12–15) relate the episode of Christ healing a leper, the story most often represented in the fine arts; in fact, that story predominates to an inordinately high degree. In all three gospel accounts, the leper humbles himself before Christ and begs to be cured. Jesus gives his assurance, touches the afflicted, and heals him. Jesus then tells the former leper to show himself to the priest and offer the gift Moses had prescribed. Minor differences can be found in Matthew’s account, in which Christ descends from a mountain followed by a crowd. Mark characterizes the leper as kneeling, and Luke places the scene inside a town. Since the events described are very similar and the texts are almost interchangeable, it is difficult to specify the source that inspired the various images. Composite portrayals of the scene commonly occur.

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Fig. 4.2  Cornelis Engebrechtsz, Naaman’s Cure in the Jordan, ca. 1524, painted panel. Detail of Naaman Triptych (fig. 7.3). (Image courtesy of Kunsthistorisches Museum, Vienna.)

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In contrast to Old Testament discussions of leprosy, the New Testament did not mention specific signs of the disease. Visual representations of Christ healing a leper are almost as old as Christianity itself, and contribute considerably to our understanding of early Christian iconography. Christian catacomb paintings in Rome favored miracle scenes. In the cemetery in the Via Latina, Rome, the oldest extant (albeit damaged) depiction showing Christ healing a leper is dated to the fourth century ce. A youthful Christ stands to the right of a kneeling bearded man. Jesus has his right hand raised in a blessing. The man does not show any evidence of disease; therefore it has traditionally been assumed that the scene depicts Mark’s story after the man had been cured.12 Five hundred years will pass before we find new depictions of this subject in Western art. These later versions of Christ healing a leper generally portray Jesus’ gesture in blessing the victim, and the afflicted is shown raising his cupped hands. Starting in the Carolingian era and continuing through the early modern period, the leprous person is shown before the miracle occurred. The depiction of physical manifestations of leprosy in victims begging for Christ’s cure apparently developed after 800 ce. Since the New Testament does not describe the diseased skin, the iconography was most likely adopted from the suffering Job, the pious and upright patriarch who was struck with ulcers “from the soles of his feet to the top of his head” (Job 2:7). The text of Job does not use the words lepra or sara’at, but medieval physicians believed the symptoms of leprosy generally started on the face and spread from there over the entire body, elements that bring to mind the wording in the story of Job, who was frequently depicted as a leprous person. Images found in the New Catacomb, Via Latina, Rome, show that the Old Testament figure of Job is indeed depicted as a “sick” man as early as the fourth century ce. In contrast to the Latin West, early Byzantine art depicted Job venerated as a leprosy saint, which may in turn have influenced Western iconography.13 An analysis of one of the six reliefs of the ninth-century Andrews Diptych supplies some clues regarding how leprosy iconography developed in the Latin West.14 The ivory carving Christ Healing a Leper (fig. 4.3) supports the supposition that Jobian iconography transferred at that time to the New Testament subject. This relief represents the afflicted person as seated, although none of the gospels texts describes the supplicant as being seated before Christ. Job, on the other hand,

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Fig. 4.3  Christ Healing a Leper, 9th century? Ivory relief. Detail of Andrews Diptych. (Image courtesy of The Victoria & Albert Museum, London.)

traditionally appears in a sedentary position since “he sat among the ashes” (Job 2:7–8; see fig. 2.1, p. 25). Skin blemishes cover the victim’s face and body. Unlike Job, however, the leprosy victim in the Andrews Diptych holds a heavy stick, possibly to compensate for his paralysis and to distinguish him from Job.15 In contrast to the other stories of Christ healing a leper, only Luke’s gospel relates the story of Christ healing ten lepers (Luke 17:12–19). The

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twelfth-century Monreale mosaic, Christ Healing Ten Lepers, presents a traditional composition and displays conventional markers of leprosy (fig. 4.4). Such multifigured compositions rarely showed great variations, although occasionally the action extends to a continuous narrative (showing a sequence of events) adding the moment when the single leper returns to give thanks to the Savior.16 Sculptures as well as paintings commonly illustrated another New Testament story pertaining to the study of leprosy iconography. At least by the fifteenth century, images of the parable of Lazarus and Dives (Luke 16:10–26) depict Lazarus as suffering from leprosy, despite the fact that, as in Job, the text does not use the term lepra. Additionally, John’s gospel describes how Christ raised Lazarus from the dead

Fig. 4.4  Christ Healing Ten Lepers, 12th century, detail of mosaic. Cathedral of Monreale, near Palermo, Sicily. (Image courtesy of Alinari/Art Resource, NY.)

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in the presence of Mary and Martha. During the Middle Ages, Lazarus of Bethany (John 11:1–43) became associated with leprosy because some legends maintained that Lazarus died of that terrible disease (the mention of smell may have reminded people of the infectious stench in lazar houses). Another connection exists, however, that ties Lazarus to leprosy: Simon the Leper (Matthew 26:6–7; Mark 14:3–4) also resided in Bethany.17 Since in the Latin Church the two biblical Lazarus figures seem to have merged, it is not surprising that St. Lazarus became one of the favorite titular saints of leprosaria.

Patron Saints of Leprosy To understand the term “saint,” one must investigate both the customs of Eastern and Western theology. The Orthodox Church divided Eastern saints into “martyrs” (people who had died for their faith) and “confessors” (those who had lived an exemplary life defending the faith); no official canonization ceremonies were required.18 Most of the medical saints of the East, like George, were said to have been born in the Orient. The twin saints Cosmos and Damian came from Arabia and Anthony Abbot lived in Egypt. Lazarus and Job originated in the Holy Land, Aegidius (Giles) hailed from Athens, Josaphat and Barlaam were from India, and Nicholas was bishop of Myra in Asia. Many of these legendary saints were said to have been martyred during the early Christian period, but all are poorly documented. Although returning crusaders did not introduce Hansen’s disease into Europe, they certainly popularized Eastern cults and legends of leprosy saints in the West. Indeed, several of these Eastern medical saints figured prominently in the development of Western iconography, in particular, Lazarus, Cosmos and Damian, Nicholas, and George. Acceptance of eastern thaumaturges and in some cases, the transfer of their relics to the Latin West, may have been intrinsically linked with the introduction of medical knowledge from the East. The Latin Church honored Christian martyrs as saints and recorded their names; moreover, since the tenth century the West required an official declaration of sainthood, supported by a papal investigation process, before declaring a person a saint. In 993, Pope John XV celebrated the first solemn canonization, that of Ulrich, bishop of Augsburg. In the twelfth century, the process of canonization was updated and incorporated into canon law.19 At that time, to gain the state of sainthood

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required proof of posthumous miracles (signa) or restoration of health of the sick at holy shrines, which became a popular subject in art (see fig. 3.5; p. 63). It is important to scrutinize the period when saints were canonized (if known), since the Roman Catholic Church’s requirements changed over the years and the cultural background is frequently of interest in theological discussions. Canonization could be initiated in a number of ways. Sometimes members of an order or an official in Rome started the procedure, other times members of a dynastic house propagated the case, and sometimes the devoted public confirmed veneration. It is noteworthy (St. Benedict is a case in point) that popular devotion frequently preceded canonization. The Western church also adopted Eastern saints, even though they lacked the credentials required by the Western church, embellishing some of the Eastern legends to establish a European connection. For example, Lazarus of Bethany and Mary were said to have lived in Marseilles; according to legend, St. Giles too ended his life in southern France. In 1087, St. Nicholas’s relics were transferred to Bari, Italy. After his return from the Third Crusade in 1194, Richard I the Lionhearted is said to have introduced the cult of St. George in England.20 In the Latin Church, when people faced calamities of death, famine, and disease, they generally placed great trust in the powers of intercessors; however, at the time when leprosy subjects appeared more frequently in art, the church did not yet fervently support intercessory saints. This only happened with the introduction of the concept of purgatory around 1270, although the institution was not fully developed until the second half of the fourteenth century, coinciding with the horrifying experience of the Black Death, when the number of intercessory saints reached their high point. Thus, there are far fewer patron saints of leprosy than there are, for example, intercessors for bubonic plague. Even though limited in number, the diversity of saints associated with leprosy, the wealth of ancient legends involved, the various functions of the images depicted, and the changing perceptions of saintly powers make the organization of leprosy saints challenging; however, it is illuminating to examine the most important iconographic patterns of leprosy saints, distinguishing between titular saints of lazar houses, saints who performed miracle cures, saints who ministered to the afflicted, and finally, saints who suffered from leprosy.21

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Saints who functioned as patrons of leprosaria predominate, and as with many saints in general, documentation shows regional preferences. According to Carole Rawcliffe, England first popularized the repentant sinner Mary Magdalene, followed by Lazarus, Lawrence, Giles, Anthony, and after his canonization in 1172, Thomas Becket, whose shrine became famous for miracle cures. Nonetheless, the most popular titular saints appeared less frequently in the fine arts than in minor arts, since their portraits decorated mostly less important artifacts: hospital seals, banners, leprosy clappers, stained glass windows, and more. The iconographic tradition of SS. George, Lazarus, and other titular saints of leprosaria remained largely unchanged throughout the period under study. Although not always directly associated with leprosy itself, many of these saintly figures allegorized theological concepts. For example, Marcia Kupfer points to the subject of Christ raising Lazarus (John 11:1–46) painted on crypt walls in St. Aignan-sur-Cher in France as signifying the importance of penance for the “sinful” sick, their relatives, and the community at large (though these observations did not specifically address leprosy victims).22 Western manuscript illuminations and architectural sculpture frequently portrayed the biblical beggar Lazarus (Luke 16:10–26) as suffering from leprosy (the English term “lazar house” is proof of that legend). From its first extant depictions in the tenth or eleventh through the sixteenth centuries, the parable of Dives and Lazarus generally appeared as a tableau vivant (scene depicting protagonists in a specific place, in frozen action with appropriate props); leprosy attributes were added only in the High Middle Ages. The fifteenth-century cloister capital of the Cistercian abbey at Cadouin shows the most important iconographic signifiers in the parable, and the Lazarus and Dives scene (see fig. 2.8, p. 40) is framed by impressive architectural details of the castle. The scene depicts Dives sitting at the feast while his dog licks Lazarus’s leg wounds. The saint is depicted as suffering; his humility and his patience made him a role model for the faithful, and endeared him to the people. My research found no such imagery in chapels of leprosaria—at least not in a narrative format.23 In Christian theology, Jesus retains the premier role as healer of sinful humanity: “Healing in medieval theology meant that it came through God’s forgiveness of sin.”24 Although Christ’s powers were unlimited, those of the medical saints were not. Doctors pronounced

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elephantia an incurable disease, and stories of miracle healings of leprous persons remained relatively rare; however, legends record a few exceptions and miracles performed by SS. Sylvester, Benedict, Martin, Francis, Elzéar, and Benitius. After legalization of Christianity, Pope Sylvester I (314–335) ruled as the first pope in Rome. He subsequently acquired a special place in the pantheon of leprosy saints. His anonymous fifth-century biography, the Vita beati Silvestri, describes, in a much-revised version, the historic events of the fourth century ce, claiming that Pope Sylvester converted, baptized, and thus cleansed the Roman emperor Constantine I (ca. 272–337) of leprosy. Thirteenth-century frescoes preserved in Rome’s Capella di San Silvestro portray the most fascinating and comprehensive version of the spurious legend. One important scene in the Sylvester story, Emperor Constantine Struck with Leprosy (fig. 4.5), depicts the ruler on his sickbed. Although the disease is an integral part of the narrative, leprosy represents a symbolic punishment; therefore, Constantine’s face and arms are covered merely with stereotypical dots, and there is no attempt to characterize his symptoms as a specific skin

Fig. 4.5  Detail of Emperor Constantine Struck with Leprosy, ca. 1240. Fresco, Capella di San Silvestro, Santi Quattro Coronati, Rome. (Image courtesy of Giovanni Rinaldi, Rome.)

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Fig. 4.6  Pope Sylvester Baptizes Emperor Constantine, ca. 1240. Fresco, Capella di San Silvestro, Santi Quattro Coronati, Rome. (Image courtesy of Giovanni Rinaldi, Rome.)

affliction. The focus of the mural—as in most Sylvester cycles—is the Baptismal Scene of Emperor Constantine (fig. 4.6). Here the sovereign appears without blemishes submerged in the baptismal font of San Giovanni Laterano. Pope Sylvester stands at the emperor’s right and is about to lay his hand on Constantine’s brow. Members of the papal court and imperial attendants officiate in the grand ceremony. Despite his role in this legend, Sylvester remained the saint primarily associated with the papacy.25 Curiously, the pontiff, though frequently depicted in medieval art, was rarely if ever, elected as a titular saint of a hospital and was not associated with any of the lazar houses (see p. 119 on these incongruities). Although the date of St. Sylvester’s canonization is not known, it may have happened soon after the fifth century when his vita referred to him as “blessed.”

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St. Benedict of Nursia (modern Umbria; 480–547) may have been canonized as a result of popular cults of devotion. Although he was not the founder of a specific order, his famous “rules” have earned him the name “founder of Western monasticism.” He is credited with many miracles, one of which is of interest here: the miracle of curing a boy stricken with elephantiasis. According to medieval legends, a father sent his son to the man of God, and Benedict restored the boy’s health. A mural commissioned by an unknown patron, St. Benedict Healing a Leper, in San Crisogono, Rome, commemorates the miracle. The iconography of the mural is based on the visual prototypes of Christ as healer of leprosy: a solemn-looking Benedict approaches from the left, extending his hand in blessing. On the saint’s right stands a scantily dressed, beardless young man, his body covered with the traditional leprosy spots. The mural is difficult to date, but it was probably created either shortly before or possibly even after the Roman Catholic Church canonized Benedict in 1220; that date coincides with the assumed apex of the leprosy wave in Europe, thus testifying to the disease’s influence on medieval theology.26 Images representing St. Martin of Tours (ca. 315–397) are based on medieval legends that describe the saint as a generous Roman soldier born in the province of Pannonia (modern Hungary). A convert to Christianity, Martin was sent as a missionary to Gaul. According to hagiographic accounts, a vision of Christ wearing half a military coat motivated the saint to share his cloak with a beggar. Not all legends credit St. Martin with the cure of the leprous person; however, scenes portraying a beggar suffering from leprosy became particularly popular in his native Eastern Europe, where realistic depictions of the illness indicate firsthand observations of infected patients. St. Martin Healing a Leper in the Cseriny Altar (Slovakia), ca. 1490, shows the destitute with both legs wrapped realistically in bandages, a convention commonly used since the 1400s to indicate leprosy victims (fig. 4.7). The kneeling balding beggar, braced by an underarm crutch, reaches up to receive from St. Martin half of his red cloak (which the saint is dividing with his sword). The healing miracle is about to begin.27 In contrast to the legendary early Christian saints mentioned above, the most cohesive group of leprosy patrons comprises historic Western personalities who emulated the example of St. Francis of Assisi (1182–1226). The saint himself had a life-altering experience when

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missing picture

Fig. 4.7  St. Martin and a Leprous Beggar, ca. 1490, painted panel, detail from Cšeriny Altar. (Photograph courtesy of Hungarian National Gallery, Budapest.)

he overcame his repulsion and accepted the mission of ministering to patients in a leprosy hospital. According to the earliest vita of St. Francis, the saint recognized Christ in a leprous beggar. In an illuminated manuscript of a Legendarium (Kepes, Hungary) executed by Master Hertul ca. 1320–30, the collection of legends contains a miniature St. Francis Caring for the People in a Leper Community. The illuminator renders the young saint kneeling in front of a basin washing the foot of a leprous man. St. Francis’s gesture and posture imitates that of Christ washing the apostles’ feet before the Last Supper; all the fellow inmates in the Hertul miniature wear large hats and the required leprosy outfits cover most of their bodies.28 To my knowledge, only one of the later biographies of St. Francis, ἀ e Little Flowers, proposed that the saint cured a person infected with leprosy. The anecdote uses almost vulgar language to describe how a leprosy patient asked the saint to give him a bath, “I will that you wash

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me all over, for I stink so foully [emphasis added] that I cannot abide myself.”29 After St. Francis complied, according to the text, the sickness left the man’s body and he began to repent his sins. On the other hand, an earlier version of the vita, written by St. Bonaventure, ἀ e Life of St. Francis (1265), recounts the saint’s gift of healing without specifically mentioning the cure of a leprous person. Similarly, the thirteenthcentury Golden Legend did not mention the cure of a leprous person; Voragine speaks merely of an incident when the saint healed a man’s festering leg wounds without specifying it as leprosy.30 Franciscan piety became one of the most powerful movements in the Roman Catholic Church in the thirteenth and fourteenth centuries. Many ascetic laypersons, even kings, queens, and nobles, followed in St. Francis’s footsteps. He became the role model, among others, for SS. Elizabeth (1207–31), Louis IX of France (1214–70), Philip Benizzi (1233–85), and Elzéar (ca.1295–ca.1323). All of these holy persons were intimately connected with leprosy, but by far the most frequently portrayed saint was Elizabeth of Hungary/Thuringia. The medical treatment she administered personally to men, women, and children suffering from disease and poverty and her achievements as founder of hospitals were unprecedented; she became an enduring legend even in her own lifetime. Daughter of the Hungarian king Andrew II, Elizabeth was betrothed as a child to Margrave Ludwig IV and the couple led a pious and ascetic life in Thuringia. Unfortunately, her husband died young on the way to the Crusades; the princess then spent her years of widowhood nursing the sick. She was canonized by Gregory IX (1227–41) as early as 1235. Less than fifty years after Elizabeth’s death, the Golden Legend dedicated a long chapter to her. It is surprising that Voragine mentions only a single leprosy patient in the extensive list of the saint’s good deeds. Nor were leprosy victims recorded among Elizabeth’s numerous postmortem miracles. As mentioned in the previous chapter, St. Elizabeth’s legends were later enriched by multiplying the number of leprosy petients in her care. An engraving by Israel van Meckenem (1445–1503) typifies the standard iconography in St. Elizabeth with a Leprous Beggar (fig. 4.8). The aristocratic saint gently lifts the covering from a crippled man, whose deformed facial features reveal that he is one of St. Elizabeth’s leprosy patients. From his kneeling position, he glances adoringly at the kind princess. Although his braces are not sufficient proof that the man

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Fig. 4.8  Israel van Meckenem (ca. 1445–1503), St. Elizabeth with a Leprous Beggar (Die Heilige Elisabeth), 1475–80, engraving. (Image courtesy of Philadelphia Museum of Art, SmithKline Beckman Corporation Fund.)

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is leprous, his single cane shaped as the Greek letter tau and a bell lying next to it, as well as the facies leprosa and his swollen knee joints, characterize the beggar’s illness as leprosy. The print depicts three crowns. Elizabeth, clad in an elegant robe, wears the crown of the House of Arpad (the ruling family of Hungary) and holds the crown of Thuringia in her right hand. The crown on the ground behind her possibly refers to the legendary imperial marriage proposal Elizabeth rejected.31 St. Elizabeth is said to have dressed very modestly and to have donated her state robes to the destitute. The engraving, however, emphasizes the dichotomy between the princess’s station in life and her humility in serving the sick and the poor. In portrayals of St. Elizabeth of Hungary/Thuringia, she generally dispenses food and medicine, not money, to leprosy patients. St. Elzéar, a nobleman born in Provence who was related to the ruling house of Anjou as well as to Pope Urban V, became famous for ministering to the leprous; he married the chaste Bl. Delphine of Glandèves. His name is French for Lazarus, similar to the Hebrew Eleazar. The saintly man became a Franciscan tertiary and died young while on a diplomatic mission to Paris. His papal godfather canonized Elzéar in 1369, and around 1374, erected a grand mausoleum to honor the saint’s memory and emphasize his dynastic affiliations. The structure must have been of political, theological, scientific, and artistic significance; it merits examination in light of the cultural milieu of Avignon’s papal court and the medical school of Montpellier. Unfortunately, the tomb was destroyed in the French Revolution and only a few marble fragments remain. The Walters Art Museum preserves one of the surviving sculpture groups: St. Elzéar Ministering to the Lepers (fig. 4.9). The fragmentary white marble exhibits the saint and three sick men. The stricken are dressed in hooded robes, as many leprosaria were organized according to monastic rules. Their costumes also comply with the prescribed dress code, requiring the infected to wear long garments and proper head coverings and footgear. The leprous state of the three is quite realistically depicted; notably they show advanced nasal deformations. On the far right side, one man displays the loss of his eyebrows and the effect on his hairline. Additionally, the stricken persons’ foreheads are all covered with oblong, confluent lepromas, forming the characteristic little craters that can be compared to the symptoms exhibited by the twentieth-century patient in figure 1.2 (p. 11). St. Elzéar’s unblemished high forehead and straight nose appear to be the antithesis to the distorted faces of the afflicted. Similarly, the

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Fig. 4.9  Anonymous French, St. Elzéar of Sabran Ministering to Leprosy Patients, marble (43.5 x 38.5 x 12 cm), ca. 1373. (Photo © The Walters Art Museum, Baltimore, MD.)

exposed fingers of the three men infected with leprosy display eruptions and deformations of the hands along with dystrophy of the nails similar to the symptoms shown in figure 1.4 (p. 14). The nobleman’s immaculately groomed, elongated fingers reassuringly cover the first kneeling patient’s hands clasped in prayer; they contrast with the deformed fingers of the supplicant, emphasizing the saint’s physical and thus also his moral perfection. The saint does not convey disgust or even fear of contagion. His demeanor indicates composure and compassion, similar to virtues St. Francis had acquired.32

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The pious story that inspired the marble group, recorded in the Acta Sanctorum, credits St. Elzéar as becoming an agent of divine power when he met and kissed six leprous men. No doubt the three inmates depicted here had something to smile about; after the saint left—so the legend goes—a sweet smell replaced the repulsive stench in the lazar house where six suffering leprous victims regained their health. In the late Middle Ages, accounts of “delayed” supernatural cures typically occur. The saints, and even the divine, were often said to have healed without instantaneous results, leaving some of the skin markers to remind the cured persons of their previous afflictions.33 St. Francis also influenced the “ideal” medieval king, St. Louis (1214–70), who supported the fratres minores in France. The king lived according to his religious convictions and took the cross in the sixth and seventh crusades. Louis died in North Africa in 1270, and was canonized only nine years after his death. Although the saint is worldrenowned, images of Louis IX in company with a victim suffering from leprosy rarely surface in art. Another saint credited with healing a leprosy victim is the Florentine Philip Benitius (1233–85). Born into the powerful Benizzi family, Philip studied medicine and philosophy and later joined the Order of the Servites. The Acta Sanctorum describes him as “confessor” and credits the monk with the miracle of giving a leprous man his cloak, curing him (cf. St. Martin’s legends). Although Philip was not canonized until 1671, four hundred years after his death, he became the Order’s first saint. One of the few images depicting St. Philip is the famous fresco cycle created in 1510 by Andrea del Sarto and others in the Florentine Church of Santissima Annunciata; unfortunately the mural is in very poor condition.34 The church itself, however, was not associated with a leprosarium; therefore, the Benizzi family may have commissioned the murals to hasten Philip’s canonization process. This discussion of saints concludes with a Good Samaritan, the first modern saint of leprosy, known the world over as Father Damien (1840– 89). He dedicated himself completely to the physical and spiritual care of the patients infected with HD, following the long line of humanitarians in the fight against this debilitating, infectious disease. He sacrificed his health and eventually his life. On October 11, 2009, the hundred and twentieth anniversary of his death, the Roman Catholic Church declared St. Damien of Molokai to be henceforth the patron saint of leprosy, HIV/

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AIDS, and outcasts.35 His saintly attributes are his leprosy manifestations, as can be observed in a large tapestry depicting the friar that hung on the façade of St. Peter’s Cathedral during his canonization mass. The portrait stressed Father Damien’s painfully marred left hand, which was placed in the very foreground of the image, and thus enlarged. E  E  E From this survey of the iconography of leprosy over hundreds of years, it is clear that the visualization of Job’s wounds was more important for the development of artistic depictions of leprosy than was the description of sara’at in Leviticus. The numerous illustrations of persons infected by leprosy depended primarily on the countless depictions of biblical lepra in the New Testament and, to a lesser extent, on hagiographic texts. Iconographic patterns changed slowly over time, from stylized abstractions to highly realistic and detailed medical descriptions of the disease. This change has been viewed as a linear development of style, but this interpretation oversimplifies the evidence. Even the Carolingian depictions registered empirical observations (albeit executed with simplistic skills) indicating firsthand knowledge of Hansen’s disease. Instead, the Sylvester cycles of the thirteenth century applied the markers mechanically, making no attempt to exhibit clinical manifestations, thus minimizing the physical illness and emphasizing a metaphorical reading of the legend. The Old Testament figure of Naaman and Emperor Constantine I represent the only two legendary victims of this dreaded scourge who play central characters in narrative history paintings. Standing in the Jordan or in the baptismal font, they appear after their cure, thus without blemishes. However, anonymous leprosy patients—whether biblical or of a later date—are rarely shown in the cleansed stage because that would make the image more difficult to read. The biographies of historic leprosy saints who had actually nursed the unfortunates indicate that the majority of these saints were born into noble families. At the time when HD was part of Europe’s experience, it was mostly the ruling classes who commissioned religious art. Needless to say, art in Protestant countries later included far fewer biblical leprosy themes, except perhaps in cabinet paintings or in illustrations of scripture, especially of Old Testament subjects (see pp. 131–50).

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The review of leprosy subjects and their iconographic traditions conveys the impression that the images derived their inspiration from a rather limited repertoire of religious literary sources. To gain a keener insight into how contemporary audiences would have viewed the imagery, it is useful to examine a variety of leprosy themes that allude to contemporary events. The visual arts preceded modern news media, and many commissions were intended not only to spread religious ideas but also to document historic events. And so, by examining works of art chronologically, we may glimpse the culture of a particular period, frequently revealing important personal messages of the patron to a very specific group of observers.

Chapter 5

Christ Healing a Leper in Christological Cycles

ἀ e Political Significance of Imperial and Royal Commissions, ca. 800–1200

Iconographic inquiries demonstrated that the first evidence depicting the cure of a leprous person occurs in the early Christian period in Rome, where scenes drew their textual inspiration from the New Testament; however, as the only extant examples of the subject of Christ healing a leper presented the cured man, one must assume that characteristic artistic signs of illness denoting victims of leprosy developed later. The ninth-century iconographic pattern, in contrast to catacomb depictions of the scene, portrays the afflicted before the miraculous healing occurred; hence the victim is still covered with skin blemishes. Some new evidence indicates that, beginning in the Carolingian period, leprosy imagery appears to be based on visual prototypes of the suffering Job. More importantly, a number of these early illustrations display empirical observations, indicating that the creators included these intentionally in order to specifically identify the illness depicted as clinical leprosy. For the examples examined here, both the names of the patrons and the circumstances surrounding the commissions are well established, facilitating and validating the implied political meaning of the individual works of art. A review of the central European political arena from the ninth through the twelfth century provides background information on how historic events inspired Western art. Beginning with Christological cycles created primarily for powerful monarchs, these scenes are seen through their eyes. Northern rulers, elected by their peers, struggled with the organization of their regions; they had to defend their territories against numerous marauders and political intrigues. During what Ernst H. Kantorowicz calls an uncompromisingly Christocentric period, the Carolingian emperors believed they 92

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had received their power directly from God and perceived themselves as Christ’s rightful representatives on earth. As part of their “Christcentered kingship,” these lay rulers sponsored missionary activities to spread the Christian faith and assumed the additional responsibility of participating in the affairs of the Latin Church by supporting the birth of a self-sufficient papal state in Italy with the pontiff at its helm.1 In turn, since the fall of Rome, popes not only served as spiritual leaders but also played important roles in the newly established political infrastructure that developed north of the Alps with the spread of bishoprics (dioceses).2 A fervent association between the spiritual and the temporal world characterized Europe of the Middle Ages, whether under a secular ruler or an ecclesiastical government. Over time this close relationship led to a fierce power struggle between the monarchs and the heirs of St. Peter, and it took centuries to establish acceptable boundaries between secular authorities and popes. Images discussed in the next two chapters attest to the tensions that arose between the two powerful political factions.

Carolingian Cycles For centuries, miraculous cures were the prerogative of Christ, indicating his divine omnipotence and his human compassion; Carolingian images conveyed complex messages reflecting this dual nature of Christ. Most New Testament cycles described the public life of Jesus, but compared to illustrations of Christ’s miracles examined later in this chapter, the ninth-century cycles were less comprehensive. Because some of these objects are traceable as having been commissioned by the highest officeholders, there is little indication that their imagery served as a didactic tool to teach the illiterate, as Pope Gregory the Great prescribed when he made allowances for religious art. Yet, the popularity of the miracle themes raises questions regarding why this particular leprosy subject appealed to rulers who commissioned the gold relief and the manuscript presenting Christ healing a leper discussed in chapter 2 (see figs. 2.4, p. 32; 2.6, p. 34). Surprisingly, within the overall production, relatively few cycles feature the subject of Christ healing a leper; an examination of the historical background further elucidates this interesting omission. After the eighth century, the renovatio imperii romani became an important mandate for the Carolingian emperors. Rulers derived from

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antique precedents their interest in educating the people and improving the human condition (as the New Testament encouraged), as well as their concern for disease. James Snyder aptly expressed the Carolingian renaissance’s intention to imbue the crowned heads with the power of the Roman emperors: “The idea of Latin Christendom as a spiritual and temporal power presiding over the affairs of the world was announced in Carolingian lauds of the eighth century: ‘Christ is victor, Christ is king, Christ is emperor.’”3 Analogous sentiments also prevailed during the Ottonian and Norman periods. Analysis of Christological cycles in general also better explains how these artworks functioned in medieval society. Scenes of leprosy carried special weight because they testified—more than most other miracles— to the Lord’s power as well as his human compassion. Ancient writers indicated what we now know for certain, that elephantiasis (clinical leprosy) was then an incurable illness. Although numerous saints were later credited with curing the blind and crippled, and even with raising the dead, they were rarely credited with healing Hansen’s disease, and we cannot infer that rulers maintained they could heal leprosy as Christ did. Including healing scenes in many imperial commissions implied that Jesus was the emperor’s divine co-ruler; thus all subjects were considered to be in good hands.4 Imperial rulers and the papacy enjoyed a close relationship during the early Middle Ages; first and foremost, Carolingian emperors functioned significantly as defenders of the Holy See. The papacy lacked military, monetary, and territorial powers to fight off tribal raids from the north and east, Saracens in the south, and Normans in the west. In addition they carried the burden of internal political problems on the Italian peninsula. Simply put, the fledgling Papal States frequently required imperial military support in order to survive. Nonetheless, the pontiffs attempted numerous times to establish their dominance over the secular rulers. They expressed their quest for might verbally, but they also demonstrated supremacy through sophisticated imagery. Pope Leo III placed a hieratic mosaic depicting an alliance between papacy and emperor in the Aula Leonis of the Lateran palace in Rome. The mural was completed just before 800, when Charlemagne’s celebrated coronation took place in the Eternal City. The original has been lost, but a copy shows that the mural illustrated the church’s perspective of a union between spiritual and temporal powers. Politically charged

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portraits within the mural conveyed the complexity of secular and religious hierarchy: on the left side, Christ enthroned presents the keys of authority to St. Peter while Emperor Constantine holds a banner of the church; on the right side, St. Peter enthroned hands the papal pallium to Pope Leo III, and the banner to Charlemagne, as Constantine’s successor. Flattering imagery and the coronation ceremony served the cause of the emperor, giving him prestige and suggesting divine protection; moreover, this important visual statement also implied the pope’s aspiration for leadership. As Gregory IV (827–844) later proclaimed, the guidance of souls was more important than temporal affairs. In contrast, the rulers defied this proclamation; Snyder explains that Charlemagne viewed himself as “chosen by God, to be the co-regent of Christ on earth.”5 Still, Charles II the Bald (823–877), Charlemagne’s grandson, followed the same ritual in 875—although under very difficult political circumstances—when Pope John VIII (872–882) crowned him “emperor of the Romans.” Charles the Bald paraphrased Proverbs 8:15 in a letter when he wrote, “You know that Christ said, ‘Through me kings reign,’ ” referring to some of his political actions.6 Similar Christocentric rhetoric is also reflected in the art objects the monarch commissioned. During the triumphal and turbulent era before his sudden and mysterious demise in 877, Charles commissioned a large gold relief (fig. 2.3, p. 31; detail in fig. 2.4, p. 32). Dates between 870 and 875 have been suggested, and scholars assume this precious object was made in Charles the Bald’s court workshop, although its location has been much debated.7 Most art historians agree, however, that the gold relief, now part of the Bible cover of the Codex Aureus of St. Emmeram, in Regensburg, represents one of the most accomplished metalworks of the Carolingian period. In the center, it features an imposing image of Jesus in a mandorla, as Judge and Redeemer, holding an open book. Surrounding him are the four evangelists and four New Testament scenes taken from the accounts pertaining to the public life of Christ. Christ and the Fallen Woman and Christ Cleansing the Temple are represented on the top of the composition and two miracle cures are placed on the bottom. The selection of the four specific events is rare if not unique. We know neither the reason for the commission nor the relief ’s original function. According to Mütherich, it possibly served as part of a precious book case (rather than as a Bible cover). The question of why Charles the Bald, who personally oversaw much of the court’s art production, chose

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these subjects may be of interest in finding answers to the many puzzling questions that still surround his reign.8 Did the scenes hold special meanings for Charles? Did they reveal some of his ambitious plans for gaining the imperial crown and securing his realm for a yet-to-be-born heir? By looking at information garnered from diverse disciplines, most importantly the biographical data taken from Nelson’s recently published Charles the Bald, it is possible to associate the four biblical scenes with events that occurred toward the end of the monarch’s life. The depiction of Christ Cleansing the Temple (John 2:14–17) may be seen as a reference to Charles’s Roman rescue missions to support the pope, who implored the monarch twice in a two-year period to cross the Alps and extend military help. The first trip to Rome in 875 ended with the imperial coronation; the second, in 877, with his death. The emperor’s herculean efforts to diminish the enemies of Rome—even at the expense of his own interests—may well be allegorized in Christ’s most decisive action against transgressions of the sanctity of the temple, a symbol of the Roman Church. Nelson interprets the ivory relief panels Labors of Hercules—which Charles most likely brought to Rome as a gift in 875—as being imbued “with special meaning for a man involved in ceaseless struggle, whose resilience and determination were needed more than ever in the fraught years after 869.”9 In my opinion, Christ Cleansing the Temple represents a biblical analogy to the Labors of Hercules. The gold relief is difficult to read, but except for the commanding upright figure of Christ, the overwhelming impression is of chaos. The scene Christ and the Fallen Woman (John 8:3–11) may refer to Charles the Bald’s second wife, Richildis, whom contemporaries dubbed the emperor’s concubine because the couple’s betrothal was celebrated only days after his first wife died in 869. Charles hoped to sire a healthy, male successor who would not become a threat to him, as had his older sons; however, none of the couple’s sons survived infancy so this dream was never fulfilled. The relief depicts Jesus bending over to write in the sand; then he addressed the crowd of accusers, “Let the man among you who has no sin be the first to cast the stone at her,” and to the woman he said, “Has no one condemned you?… Nor do I condemn you.”10 The relief on the lower right side, Christ Healing the Blind (Mark 8:22–26), shows a young man escorted by one of the apostles. Christ turns toward the petitioner and touches his eyes; the petitioner, in contrast to the leprous person in the adjoining relief, wears elegant clothes.

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Perhaps Charles the Bald felt remorse and sought absolution for having his own son Carloman in 873 blinded for personal political gains when Charles was intent on becoming emperor, a plan he brought to fruition two years later. Most certainly, few rulers combined religious faith (mixed with idiosyncratic superstition) and political tenacity to the same degree the ambitious Charles the Bald exhibited in his efforts to rival the deeds of his namesake Charlemagne.11 And like his grandfather—and so many rulers after him—Charles the Bald used the arts strategically. The final relief, Christ Healing a Leper (Matt. 8:1–4), situated in the lower left-hand corner (fig. 2.4, p. 32), shows a man approaching Christ from the right. Two apostles follow their master; halos distinguish all three sacred persons. The sick man bears the markings of leprosy covering all of his exposed skin, most noteworthy on the ridge of his nose. He also displays the uncommon and puzzling indentations on the chin area (see fig. 2.6, p. 34). Barefoot and leaning on an underarm crutch, the afflicted wears his “garments rent” and extends his hands toward the Savior. The scene takes place outdoors, as indicated by the lush vegetation filling the space between Christ and the leprous man. For years I have suspected that Charles suffered from leprosy, in part because his nickname Carolus Calvus (bald-headed), already recorded during his lifetime, has never been satisfactorily explained in posthumous literature.12 Yet the loss of facial hair and receding hairline is one of the indicators of leprosy. Aretaeus (second century ce) wrote that thin hair growth was characteristic of patients suffering of elephantiasis. The ruler’s portraits give some indication of changes in Charles’s appearance. An early portrait (First Bible of Charles the Bald, ca. 845– 851), portrays the crowned monarch’s rich dark hair; about twenty years later, in the Double Portrait with Richildis (frontispiece of San Paolo fiore le mura Bible, after 870), the sovereign’s crown seems to cover most of his forehead down to the ears, and no hair is exposed. Nelson correctly observes that Charles the Bald sports a “distinctive, long, thin mustache (not quite like his eldest brother’s)”; however, Nelson does not imply that the thin beard could relate to Charles’s nickname.13 Another suspicious factor in the equation indicates the possible presence of HD: the horrendous stench recorded after the emperor’s death. Body odor and fetid breath have been consistently mentioned as a univocal manifestation of leprosy victims since they are caused by the deterioration

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and breakdown of the flesh. Charles’s body decomposed very rapidly, exuding such a terrible stench that the litter bearers refused to carry the corpse farther so it could be entombed in St. Denis, as was the sovereign’s last wish. Perhaps they were afraid of infection? Instead, the emperor was buried hastily near Lyons—albeit only for a period of several years—before his remains were laid to rest in the venerable abbey where Charles functioned as its lay abbot toward the end of his life.14 In order to clarify the state of affairs in 875, minor events in Charles’s life deserve revisiting. Although he was reported as being sickly during the last years of his reign, Charles the Bald undertook a strenuous campaign to assist Rome even after he had already gained his most coveted prize, the imperial crown. Did he hope for a cure, like Constantine in the legend of St. Sylvester, as a reward for bringing rich gifts and military aid to the pope? Nelson assumes Charles suffered fever attacks of malaria; certainly any number of diseases could have caused his death in 877. Or was the emperor really poisoned by his court physician, Zedechias the Jew? It is important to be aware that the medical questions remain unresolved, and his nickname has not been convincingly explained. Furthermore, perhaps the magnificent Codex Aureus with its four biblical scenes— though possibly fraught with encoded political tropes—may more fully explain the tumultuous last years of Charles’s reign.15 Only a DNA test could supply us with a definitive answer, as it did in the case of Henry VII, called the Lame, Frederick II’s son, who suffered from leprosy. Unfortunately Charles the Bald took his secrets to the grave.

Ottonian Cycles Ottonian depictions of Christ’s miracles contain some of the most complete cycles in Western art history, as Albert Boeckler notes in his thorough study of the iconography of these works. Although less popular than other miracle subjects, leprosy images appeared only in the most renowned gospel books.16 The cycles stress the importance of Christ and his empowerment of secular rulers. Reviewing the political situation after the year 1000 shows that Ottonian rulers and the popes reach an unprecedented equilibrium in their relationship. The negotiations between the two powers play out according to their mutual interests, centered on a common goal of making Latin Christianity the universal religion in Europe. Although the Ottonian dynasty practiced lay

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investiture and influenced the elections of the pontiffs, the rulers also donated large territories to the Papal State. The boy-wonder of the world Otto III (980–1002) was crowned king at the age of three. After his father, Otto II, died at the age of twentyeight, his mother, the famous Byzantine princess Theophano, became regent in Germany. At her death, Otto III ascended the throne in 996, as the first Holy Roman Emperor, crowned by his cousin, the newly elected Pope Gregory V. When the pope died in 999, the emperor was instrumental in the election of his friend and advisor, the learned Gerbert of Aurillac, as Pope Sylvester II.17 Together they played out the fictitious scenario of St. Sylvester and Constantine, traditionally regarded as the model of papal partnership with the emperor. It was the brilliant Sylvester II who encouraged Otto III to envision a Christian Roman Empire. Thus, the young monarch further enlarged the territories of the Papal State. Interestingly, the emperor insisted that his endowments to Rome were not based on the precedent of the Donation of Constantine, which he considered a fake (see pp. 108–11).18 Bishop Bernward of Hildesheim, the emperor’s former tutor and councilor to Theophano, brought about a flowering of the arts during Otto III’s reign. Exquisite art productions exhibited both classical and Byzantine influences, and monumental Christological cycles depict Christ healing a leper, in sculpture as well as in murals. The large fresco cycles survived in only two places: the late tenth-century churches of St. George in Reichenau-Obernzell and Goldbach on Lake Constance.19 Sculpture too depicted Christ’s public life, including the miracle of Christ healing a leper. The spiraling relief of the bronze column for the Church of St. Michael in Hildesheim constitutes one of the most impressive Ottonian examples. Cast between the years of 1015 and 1022 and standing over twelve feet tall, its design imitates ancient Roman triumphal columns.20 Ottonian book illuminations provide a particularly fertile ground for studying the biblical cycles. Dated around the year 1000, the remarkable Gospel Book of Otto III represents one of the most intellectually accomplished as well as one of the most visually appealing imperial manuscripts. The book reflects the increasing attempts to revive antique knowledge, particularly in the Benedictine Abbey of Reichenau (Augia), a renowned center of learning, and thought to be the place where the gospel book was created. The folio Otto III Enthroned Between Church and State portrays

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the youthful ruler as “Christlike,” dressed in the same colors Jesus wears in the miracle scene (see below). The illustration pays tribute to the divinely appointed ruler and, according to Snyder, the Gospel Book expresses a version of caesaropapism similar to the practices in Byzantium.21 The ninth-century miniature Christ Healing a L eper (from Gospel Book of Otto III, discussed in chapter 2, figs. 2.6, p. 34; 2.7, p. 36) recounts the biblical story in two phases, with “before” and “after” pictures.22 The upper register portrays Christ’s encounter with the man who suffers from leprosy. Jesus, larger than the other figures and dressed in royal purple with a pale blue undergarment, is clean-shaven; his halo is marked with a cruciform symbol. He advances toward the sick man and extends his right hand in blessing. The afflicted devoutly genuflects, while his hand gesture suggests that he implores the Savior to cure him. Dark-complexioned, the petitioner’s face is covered with sores, as is the rest of his body. He wears a short olive-colored garment, and has a large horn slung over his left shoulder. All eyes are directed toward Christ, who focuses his gaze on the infirm. The two figures exchange glances, heightening the drama. The apostles’ postures express apprehension. Few details indicate where the scene takes place; the monumentally conceived figures stand on a verdant carpet of grass, which serves also as a division between the upper and the lower register. Jesus and the leprous man meet on equal footing. In the scene below, the former patient presents two doves to the temple priest (“what Moses prescribed”) as Christ had advised him to; the priest raises both arms to indicate his surprise when he sees the physical changes. It is important to point out that they too meet at the same level inside the vaulted tabernacle; in Old Testament leprosy scenes, the victims were treated quite differently visually. Here, however, the enthroned, haloed temple cleric holds a large tome in his lap; some scholars have suggested that he represents a precursor of Christ. The cured man’s hair has grown back and is now styled like that of a young apostle. Exonerated from sin, he appears to have regained not only his health but also his status in high society. He is dressed in violet-colored garments with heavy gold embroidery on the borders and is deemed worthy to reenter the house of worship. This additional scene is only rarely shown and was presumably based in part on Old Testament texts and imagery. The transformation of the leprosy victim from outcast to reinstatement to his former station in life, indicated by his elegant

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clothes, means more than just a change of wardrobe; it represents the restoration of his persona, an important factor in medieval life.23 This Ottonian miniature Christ Healing a Leper deliberately adopted cues from the Old Testament as a lesson regarding Christ’s spiritual powers and his intention to update the law. Israelites suffering from leprosy were excluded from society; in contrast, the Savior commanded his disciples to minister to the unfortunates: “Cure the sick, raise the dead, and heal the leprous” (Matt. 10:8). At the same time, other words of Christ can be invoked: “Do not think that I have come to destroy the law of the prophets. I have not come to abolish them, but to fulfill them” (Matt. 5:17). These gospel texts appear to have served as guiding principles in the Ottonian depiction of Christ Healing a Leper.24 As the Ottonian dynasty’s power diminished by the middle of the eleventh century, the precarious alliance between the Holy Roman Emperors and the papacy changed to a strained relationship. Both sides had valid reasons for their actions that contributed to this development. Pope Gregory VII (1073–85) aimed to establish God’s empire on earth, but his church reforms caused a rift due to resentment over his attempts to curb secular interference in ecclesiastic affairs. The emperors felt justified in fostering future allies by selecting religious leaders in their own territories as well as in those lands granted to the popes. The Investiture Controversy culminated in 1077 when Henry IV of Germany was forced to beg the Holy Father to release him from the imposed interdict and reverse his deposition, which had encouraged a rebellion within Germany. It is noteworthy that as the Papal State gained in power and established itself more firmly in the Western regions, the heirs to St. Peter’s throne lost more and more influence in Byzantium. The final separation took place in 1054, about the time that Rome first officially mentioned the spurious Donation of Emperor Constantine to Pope Sylvester I. The continuing struggle to establish the primacy of the Holy See in the Latin West brought further political changes.

Norman Cycles By the twelfth century, Norman kings in Italy had gradually taken over the protective role of the Holy Roman Emperors. For many reasons, Rome favored this new alliance. Norman expansion policies and reChristianization attempts in the Arabic regions, along with a common front against Byzantium, united the former foes; thus the popes and

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the Norman invaders became closely aligned. Not surprisingly, images reflecting similar aspirations of a Christ-centered rule prevailed in the decorations of the Cathedral of Monreale, the grandiose foundation of the Norman monarchs in Sicily. As had the Ottonian rulers before him, King William II (1172–89) saw himself as divinely installed; he expressed this visually in the mosaic Christ Crowning William II in the Cathedral of Monreale.25 Scholars now agree that the church mosaics were probably completed not long after William II’s death in 1189. A Norman document of circa 1000 emphasizes a comparable concept in declaring the “king” as holy, as priest, and as messiah (“Rex sanctus est, Rex sacerdotus est, Rex Messias est”). Fusing the office of king with that of messiah implies a God-given kingship.26 Accordingly, we find analogous attitudes expressed in the wealth of Christological subjects decorating the church built to adjoin the royal residence outside Palermo. Recognized as one of the most successful syntheses in a hybrid culture, the Monreale mosaics carefully balanced western/Latin, eastern/Byzantine, and Arabic/Islamic trends. Monreale’s impressive church decorations can be compared with the Sistine Chapel in their harmony of subject matter and their grandeur of design. Although Monreale’s mosaics prominently illustrate the Creation and other Old Testament scenes in the main nave, overall, the mosaics focus on the Redeemer. The gigantic Pantocrator in the apse dominates the cathedral and Christ’s figure appears in around seventy scenes. Acknowledging the close relationship of the Norman kings with Rome, stories of the apostles Peter and Paul complete the cathedral’s encompassing iconographic program. Among the many depictions of miracles, Christ Healing a L eper (fig. 5.1) in the right transept and Christ Healing Ten Lepers (fig. 4.4, p. 77) in a corresponding location in the left transept, stand out because the victims are portrayed with dignity and compassion. Monumental in composition, these two scenes are unique in leprosy iconography, considering their grand scale as well as their elegance. However, the manifestations of the disease encountered here are quite traditional, merely symbols identifying leprosy. Christ Healing a L eper shows the cross-nimbed Savior descending from the mountain followed by a crowd; he approaches from the left. Jesus reaches out to the afflicted in front of the city gate. The leprous man is partially nude, covered with sores from head to foot. The

Christ Healing a Leper in Christological Cycles

Fig. 5.1  Christ Healing a Leper, 12th century, detail of mosaic. Cathedral of Monreale, near Palermo, Sicily. (Image courtesy of Alinari/Art Resource, NY.)

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narration follows Matthew’s text, except for the introduction of a town, a detail mentioned in St. Luke’s gospel. Not mentioned in scripture is an association of lepra with paralysis, skeletal deformation, and so much more. Yet the sick man carries a cane, although he seems to stride purposefully and confidently toward Jesus to receive his blessing. Clearly the intent was not to emphasize debilitating disease, but the man’s faith in Christ. The landscape of stylized mountains continues in the neighboring scenes representing other miracles and sets the stage for positive messages to inspire the faithful. On the opposite side is a representation of Christ Healing Ten Lepers, where a similar city gate frames the event. It features Christ carrying the scroll, followed by apostles, with Peter and Paul in the foreground. Jesus meets the group of the stricken with his right hand extended in a Greek blessing. The ten men are barefoot with markings similar to those of the single leprous supplicant seen on the other side of the choir. The men gesture frantically to gain Christ’s attention. The greater number of figures projects an increased vitality; however, this dynamic does not detract from the ceremonial dignity.27 Since the artist adhered closely to Luke 17:12–19, the passage is cited in its entirety: On his journey to Jerusalem … as he [Christ] was entering a village, ten lepers met him. Keeping their distance, they raised their voices and said, “Jesus, Master, have pity on us!” When he saw them, he responded, “Go and show yourselves to the priest.” On the way there they were cured. One of them, realizing that he had been cured, came back praising God in a loud voice. He threw himself on his face at the feet of Jesus and spoke his praise. This man was a Samaritan. Jesus took the occasion to say, “Were not all ten made whole? Where are the other nine? Was there no one to return and give thanks to God except this foreigner?” He said to the man, “Stand up and go your way; your faith has been your salvation.”

Although for formal reasons the returning leper is not depicted, one wonders if the city of foreigners, whose diverse population was frequently under pressure to convert to Christianity, was targeted with this appealing message of conversion? One also wonders if leprosy posed a grave danger to the population of Sicily, the ancient multicultural melting pot in the Mediterranean Sea.28

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E  E  E We have seen that scenes portraying the sick, the blind, the crippled, and especially the leprous presented the divine Savior as exercising misericordia. Secular sovereigns or members of their intimate circles commissioned many murals and illuminated manuscripts depicting these miraculous events. The three examples presented here denote the personalities of the rulers who commissioned them: Charles the Bald, Otto III, and William II. The biblical cycles convey the bond between Christ and his flock and, by analogy, between the Christian potentates and their subjects. Yet in the depicted scenes, the supplicants remain part of the supporting cast and are characterized as ritually unclean, clad according to the biblical command, “The one who bears the sore of leprosy shall keep his garments rent” (Lev. 13:45). Despite the disheveled and demure appearance of the stricken, the scenes generally focus on the figure of Christ and the victims, searching for salvation, seem remote from the viewer. The images focus less on the physical cure than on the faith that made the miraculous healing possible. We have seen that leprosy themes attracted a specific patronage and were far less often chosen for depiction than, for example, the healing of the blind.29 The innovative leprosy scenes in these three Christological cycles represent a novel religious artistic expression of power that paid tribute to the glorious rulers largely by equating them with Christ, with the overriding message that the secular rulers’ authority was, in fact, God’s authority. These images invoked Jesus and were intended to empower and inspire heads of state to achieve great deeds in the name of religion. In the chaotic and disruptive process of creating a civilized Europe, the chosen images accentuating an omnipotent Savior may have been intended to evoke feelings of security. All three cycles allegorize a Christ-centered kingship and also accentuate the close relationship of the lay rulers to the successors to the apostle princes Peter and Paul. After 1200, secular powers in Europe lost their central position and the political situation deteriorated further. Mendicant orders attacked the worldliness of the papacy. With the loss of royal and imperial patronage, art production became less homogenous. At the same time, a wealth of innovative iconographic themes developed that were primarily concerned with saintly individuals not recorded in scripture, but in the Golden Legend and other hagiographies. Thus the next chapter

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will feature prominently the politicized iconography of the legendary “leprous” Emperor Constantine healed by St. Sylvester, and other pious stories of leprosy saints.

Chapter 6

Patron Saints of Leprosy and ἀ eir Images in Religious and Political Contexts, ca. 1200–1800 In studying images that portray legends involving leprosy subjects, it is important to bear in mind the immediate historical and theological background and that these monumental paintings, precious reliefs, and illuminated manuscripts were created for an audience that was politically informed. By choosing securely dated examples—even if the work’s patron is unknown—its patronage can be narrowed down to a powerful special-interest group, either secular or ecclesiastical. Based on circumstantial evidence mentioned in chapter 3— increased building programs of leprosaria, inclusion of eastern medical knowledge, development of church ordinances, canonization and depictions of leprosy saints, and more—it is reasonable to assume that leprosy cases increased in the eleventh, twelfth, and thirteenth centuries. During the same period, Europe’s political structure also changed considerably. While secular rulers lost some of their prestige as protectors of the papacy, the Roman Catholic Church gained power for several reasons. First, Europe’s almost universal acceptance of Christianity after the year 1000 and the ensuing Crusader spirit changed the continent. Second, the Gregorian Reform in the eleventh century attempted to create God’s realm on earth under the leadership of St. Peter’s successors and condemned all secular interference in church affairs, sparking the Investiture Controversy of 1075 to 1122. The popes gained the power to wield sanctions against monarchs, including the interdict; the excommunication of a head of state could result in excluding all of the faithful in the kingdom from participation in the sacraments and could result in challenges to the monarch’s authority. In retaliation for the threat of excommunication, the emperors often sided with the Roman nobility in their disputes with the Papal State, resulting in more frequent elections 107

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of antipopes who challenged the authority of the sitting pope.1 Third, the much-debated forgery, the Donation of Constantine, played an unprecedented role from 1179 to 1254 as the church used it in attempts to assert their authority to settle territorial disputes. Propagandistic images depicting Pope Sylvester curing Emperor Constantine of leprosy mirrored, at times most dramatically, the political tension between the two universal powers; however, the literary sources on which the illustrations were based lacked factual foundations. In order to understand why the Latin Church adopted revisionist accounts of the lives of Constantine I (272–337) and St. Sylvester (pope 314–35), one must investigate some contradictory documents. Eusebius of Caesarea wrote the Life of Constantine shortly after the emperor died in 337; modern scholars therefore have accepted his version as mostly authentic. According to this vita, Constantine was baptized on his deathbed by the local bishop, Eusebius of Nicomedia, in the city where Constantine suddenly fell ill during his campaign against the Persians.2 Pagan Roman law had dominated Constantine’s reign, and he did not perceive himself as a Christian ruler, as posterity later portrayed him. As pontifex maximus, Emperor Constantine supported the recently legalized (313) Christian Church in order to avoid divisive controversies in his realm. From his new eastern capital of Constantinople, Constantine summoned several church councils to settle disputes within the church. The most important of these was the First Council of Nicaea, which was convened to deal with the Arian controversy and which Pope Sylvester declined to attend. The emperor’s sympathies may have leaned toward Arianism, but he did not interfere with the church’s decision when, in 325, the council condemned the teachings of Arius (250–336) as heresy.3 Possibly by the fifth century, the Latin Church objected to the fact that both the author of the vita and the baptizing bishop had Arian associations. Therefore, from the Western vantage point, these Eastern bishops were heretics, which could jeopardize the validity of the sovereign’s baptism. For these and other reasons, the apocryphal fifth-century Acts of Sylvester (Vita beati Silvestri; see p. 81) may have been accepted as genuine. This biography embellished the relationship between pope and emperor and proclaimed that Constantine’s conversion and baptism by St. Sylvester had cured him of leprosy shortly before he left the Eternal City. 4

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Some of the claims of the spurious Donation of Constantine were in fact valid. The emperor did donate to the pope a number of Christian churches in Rome, but the so-called privileges cited in the document far exceeded the imperial concessions. In 1054, Pope Leo IX (1049–54) availed himself of the Donation for the first time and afterwards a number of papal decrees cited it to support territorial claims. Thus the issue became a bone of contention between and among Latin rulers, the Holy See, and the Byzantine emperors. International scholars who recently scrutinized the document did not reach a consensus regarding its authorship and the circumstances in which it was composed; however, the majority agreed that the forgery was probably produced between 750 and 850, since the Constitutum Domini Constantini Imperatoris was confirmed in the Frankish realm as early as the ninth century. This document claimed that the emperor bequeathed St. Sylvester temporal power over Rome and the Latin empire as a gift in return for the emperor’s restoration to health.5 An ironic postscript to the Sylvester story discloses a little-known incident in Constantine’s life. Mollat’s ἀ e Poor in the Middle Ages recounts that the emperor had one of his officials, Zoticos, executed in Constantinople for disregarding the imperial edict on the leprous. Out of concern for public health, Constantine had decreed that persons infected with leprosy should be either killed or expelled from the realm, but Zoticos apparently used public funds to build a makeshift leprosarium outside the gates of the capital. Constantine later repented his action and had a hospital built on the site where his official had cared for the ill, naming it after the “martyr.” One can speculate that the emperor’s un-Christian behavior may even have contributed to the fifth-century vita associating him with leprosy, although he was not the only Roman emperor accused of being infected with that dreaded illness.6 This negative incident, in addition to other reasons, may have influenced the Latin Church’s decision not to revere the emperor as a saint, as was customary in the Eastern Church.

ἀ e Legend of St. Sylvester Curing the Leprous Emperor Constantine Leprosy had a noticeable presence in Europe in the High Middle Ages, and since the disease played a pivotal role in the Sylvester story, it is not surprising that the legend became a metaphor for the hostilities that developed between the Hohenstaufen dynasty and the reform popes

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in the twelfth century.7 At the beginning of the thirteenth century, extensive Sylvester cycles developed in and around Rome, as well as in religious centers such as Chartres, and later in Cologne, Florence, and many other places. The iconography of Emperor Constantine’s illness and his baptism were mentioned briefly in chapter 4 (see figs. 4.5, p. 81; 4.6, p. 82). One of the first monumental treatments of this subject appears in the apse of Tivoli’s San Silvestro. This Romanesque basilica confirms that the ancient Roman city also played an important role during the Middle Ages. The altar niche depicts an extensive theological program organized in several tiers. A gigantic Christ Handing the Law to St. Peter and a S croll to St. Paul dominates the conch. The concept of a divine hierarchy and the subject of the transfer of power from Christ to the two apostles—and by implication to the Latin Church—are reminiscent of the eighth-century mosaic created for Charlemagne’s coronation at the Lateran Palace (discussed in chapter 5, pp. 94–97). The section below represents, in a narrow band, the Lamb of God encircled by twelve lambs symbolizing the apostles. The area below that frieze is allocated to the enthroned Virgin and Child surrounded by a court of saints. Below that but above altar level, a figurative frieze highlights the healing and baptism of Constantine. The frescoes were most likely executed in the first quarter of the thirteenth century. For years art historians have speculated on the mural’s implied political message, reflecting the eventful years and changing political alliances of that period; however, without firm dating, a definitive answer regarding the mural’s meaning remains out of reach. As far as is known, the paintings were not a papal commission, though it has been suggested that similar imagery could have adorned Old St. Peter’s in Rome (now lost).8 Constantine’s narrative is much expanded in the most extensive, best preserved, and now almost completely restored Sylvester cycle displayed in Rome. The Capella San Silvestro, designated as a private chapel for the Holy Father and the Curia, was added to the monastic complex of the ancient basilica Santi Quattro Coronati, firmly aligned with the papacy since it stood in close proximity to the Lateran. The Romanesque frescoes were probably painted in 1246 when the chapel was consecrated. It would be difficult to overstate the importance of the feudal customs and ceremonial insignia depicted in these propagandistic wall paintings that refer very specifically to the privileges mentioned

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in the Donation of Constantine. The large frieze, placed above eye level, recounts the fascinating legend. As the focus here is on politics and scenes of leprosy, and for the reasons already stated, the cycle will serve as a model for other discussions of the Sylvester subject.9 The Sylvester cycle begins on the high vaulted west or entrance/ exit wall, which confronts the visitor with a monumental painting of the Last Judgment. A powerful, seated Christ figure shows most of his upper body exposed in an attempt to display his five wounds prominently. Two angels float above the divine judge, flanking him at shoulder height. The one on the left, using both hands, deftly rolls up the firmament like an ancient scroll, leaving the sun, moon, and stars still visible. The image vividly recalls the words of Revelation 6:15: “Then the sky disappeared like a scroll being rolled up” (Vulgata: “et caelum recessit sicut liber involutus”).10 The angel on the right blows the trumpet. Mary and St. John, forming a deisis, display the instruments of the Passion. The somewhat unusual symbolism underlines Christ’s sacrifice for humanity. Below the figure of Christ the Judge, on the lower register, Constantine’s actions undergo divine scrutiny: God had struck the emperor with leprosy as punishment for persecuting those of the Christian faith. The lower left section illustrates Constantine’s rejection of the cure suggested by his pagan physicians: a bath in the blood of three thousand children. The enthroned leprous emperor faces a crowd of agitated mothers clutching babes and pleading for their lives. Indeed, the legend emphasizes Constantine’s refusal to accept the sacrifice;11 thus God would forgive the emperor and give him another chance. That night on his sickbed, shown here with his face and arms covered with stylized leprosy markers, Constantine sees SS. Peter and Paul in a visionary dream (see fig. 6.1). The two haloed apostles extend their arms as they tell him to look for his cure to Pope Sylvester, who, with his congregation, had gone into hiding outside Rome in order to escape Constantine’s alleged raids. The emperor quickly sends envoys to bring Sylvester to his palace. Turning the corner to the adjoining north wall, the cycle depicts the papal camp and the pontiff receiving the imperial messengers. Then the action shifts back to the palace, where Constantine, about to be converted, is still disfigured by leprosy. Sylvester, portrayed as a tonsured, haloed saint, introduces the crowned, deferentially genuflecting monarch to a double icon of the apostles Peter and Paul. The emperor recognizes them as the figures in his nocturnal vision. Next,

(Image courtesy of Giovanni Rinaldi, Rome.)

Fig. 6.1  Detail of Emperor Constantine Struck with Leprosy, ca. 1240. Fresco, Capella di San Silvestro, Santi Quattro Coronati, Rome.

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we see Sylvester curing Constantine with the waters of baptism (fig. 4.6, p. 82). The sacramental scene provides the focal point of the long wall, presenting Constantine half submerged in the font—the emperor’s skin blemishes have vanished—and the pope lays his hand on the monarch’s forehead. Attendants, similar to the angels in Christ’s baptism, hold the imperial garments and the jeweled crown. The differences between the clergy and members of the secular court are carefully portrayed. The last two scenes of the legendary account are original in Constantine’s iconography, reflecting his gratitude and acknowledging that the emperor has now become a vassal of the pope. The first scene after the cure represents a monk holding a cruciform staff and attending the enthroned Sylvester, who wears the bishop’s miter of Rome. The emperor, again kneeling and now bareheaded, shows his submission as he receives the papal blessing. In the background one guard holds the imperial crown, which the pope had modestly refused to accept. Constantine, multitasking, with one hand offers Sylvester what looks like the precursor of the papal tiara (without the three gold bands) while with the other hand he reaches for the reins of a white stallion whose saddlebag contains a large document, most likely the Donation of Constantine (fig. 6.2). Exceptional in Sylvester’s iconography, in the following scene Constantine renders the humbling officium stratoris, leading St. Sylvester’s white charger on foot, like a groom. The emperor is preceded by his own sword carrier, also on foot, as he leads the way to the Lateran Palace, the “new” papal residence (fig. 6.3). The cardinals follow the pope on grayish-brown horses because the Donation promised as one of its privileges that the Curia, in future processions, would rank equal to Roman senators. Difficult to see in the illustration is the white-robed monk carrying a large processional cross and leading the cavalcade to the gate. He is riding a donkey, much like Christ in the entry into Jerusalem.12 Every scene of the cycle, without exception, describes in minute detail the power structure of church versus state. The scenes are outstanding in their poignancy and adroitness in rendering action, always emphasizing the division between the temporal forces and the ecclesiastical members of the cast. The patron who commissioned the cycle remains unknown. We know, however, that the story of the fictitious document about the transfer of power to the papacy held a special meaning during the controversial reign of Innocent IV (1243–54). He proclaimed that the popes

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Fig. 6.2  Detail of Constantine Offers the Tiara to Sylvester, ca. 1246. Fresco, Capella di San Silvestro, Santi Quattro Coronati, Rome. (Image courtesy of Giovanni Rinaldi, Rome.)

should rule supremely over earthly princes since “Christ had invested Peter and his successors with absolute temporal as well as spiritual sovereignty.”13 During his reign, the conflict between the papacy and Emperor Frederick II reached its climax, though Innocent IV waged his attacks from the safe distance of France, where he convened the Council of Lyons in 1245. He declared the emperor, in absentia, a heretic and stripped him of his imperial powers, releasing his subjects of their oaths of allegiance. In the 1240s, when the Santi Quattro frescoes were designed, Cardinal Conti, Innocent’s representative during the pontiff ’s absence from Rome, fortified the church complex. There may have been good reason to fear an attack by the imperial army. The fresco cycle visualizes the papal position—intended to remind Frederick II what he owed his Creator and therefore also St. Peter’s heirs, as guaranteed in the Donation of Constantine. The politically charged mural might also project a future scenario, foreseeing the pope’s triumphal return from France to Rome and

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Fig. 6.3  Detail of Officium Stratoris, ca. 1246. Fresco, Capella di San Silvestro, Santi Quattro Coronati, Rome. (Image courtesy of Giovanni Rinaldi, Rome.)

Fredrick II’s submission to Innocent’s wishes. The innuendo-laden cycle was created at the critical moment when the two powers—papacy and emperor—could not agree on a compromise. Many personal and political setbacks marked the last decade of Frederick II’s life; these tribulations drained the vitality of the imperial force. After Frederick’s death, the Great Interregnum (1250–73) began. Various examples of the Sylvester story depicted outside the papal realm are also of great interest since they, too, are imbued with various religious and political objectives.14 A similar cycle—though with a different agenda—was created in Cologne. In 1322, fewer than a hundred years after the Capella San Silvestro was completed, the imposing gothic choir of the cathedral in Cologne was completed; soon after that, a large Sylvester mural enhanced its walls. The planning and execution of the frescoes coincided with equally turbulent times that gave form to the Roman Capella San Silvestro. Seppelt characterizes this era as the last struggle between the imperial and the ecclesiastic forces. The political situation resembles that experienced during the Interregnum when the

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throne of the emperor remained empty. In fact, in 1314, only eight years before the Cologne choir was consecrated, two rival German kings were elected: Louis IV of Bavaria and Frederick of Austria. In this double election, the votes of the seven imperial electors were divided: three for Frederick (the archbishop of Cologne and two secular electors) and four for Louis, the Bavarian candidate. King Louis insisted that he had been elected by a majority and without waiting for the pope’s approval, assumed the position of the emperor designate. This action offended Pope John XXII (1316–34). Holding court in Avignon, the pontiff determined that it was his right and duty to decide which one of the two candidates should be crowned as the Holy Roman Emperor. Since Louis disregarded Pope John’s warning, he was excommunicated, causing a war in which Louis took Frederick, the anti-king, prisoner.15 The sophisticated innuendoes of the painted series refer not only to the then-current tense political situation but also to Cologne’s glorious past. Romans founded the city on the site where in 310 the young and adventurous Constantine had built the first stone bridge across the Rhine River, opening the eastern territories of Europe to Roman trade and cultural exchange. Toward the end of the Middle Ages, the fortuitously situated mercantile center of Cologne was the largest German city and certainly one of the wealthiest. Not surprisingly, the city acquired numerous precious relics, among them the (partial) head of St. Sylvester and the famous relics of the biblical Three Kings. As residence of the most powerful of the three ecclesiastical prince electors, the new gothic cathedral represented the town’s affluence as well as its spiritual aspirations. These political events may very well have influenced Cologne’s cathedral decorations. The painted program, finished by the middle of the fourteenth century, included on the south side portraits of all the Holy Roman Emperors and German kings. The north wall depicted all bishops and archbishops of Cologne. Above the images of the monarchs, appear narrative scenes recounting the lives of the Virgin and of the Three Kings. The lives of St. Peter and St. Sylvester are placed, very appropriately, above the images of the clergy. Significantly, the Sylvester series occupied twice the space allotted to any other narrative topic. The fourteen bays (each divided into two distinct scenes) depict in great detail the youth and persecution experiences of Sylvester, characterizing the pope as a holy man and a confessor. The use of contemporary attire

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introduces a surprising element. For example, St. Sylvester’s legendary enemy Tarquinius, the Roman prefect who had the saint imprisoned as a Christian, is depicted here in contemporary attire (fig. 6.4). The figure can be identified by the inscription “Tarquinius prefectus” and by his headdress, the Kurhut. Although he is depicted interrogating Sylvester, Tarquinius is clad as a secular elector (Kurfürst), possibly representing the elector who exercised the swing vote in this critical imperial election when Cologne’s candidate lost his race to become emperor. Similarly, the ecclesiastical ceremonial vestments in the adjoining scenes are also very carefully rendered to express firm allegiance to the reigning pope.16 On the other hand, the scenes displaying Constantine’s refusal to spill innocent blood to regain his health, his dream, and preparation for his baptism are rendered quite traditionally. Unique in the Sylvester iconography is the scene where Constantine actually places the papal tiara on the pope’s head. This would indicate that the emperor should by no means be ranked below the pope—a fitting and diplomatic statement by the archbishop of Cologne, who was doomed to serve two powerful masters: an imperial ruler and the Roman pontiff. The St. Sylvester Window in Chartres, dated ca. 1220, deals with very different theological issues and may have been intended as a warning to all heretics who opposed the teachings of the church. Collette Manhès-Déremble, in Les vitraux narratifs de la cathédrale de Chartres: Étude iconographique, explains that individual windows in the choir where the Constantine/Sylvester legend is preserved were dedicated to rectify unprecedented political events in France. In her opinion, these didactic images were concerned primarily with heretical questions surrounding the Christian sacrament of baptism; the choir windows of Chartres display no fewer than twelve baptismal scenes. Created in the thirteenth century, at the height of the crusade against the Cathars or Albigensians, the images decried the call for a “spiritual baptism” instead of baptism by water. The composition of the Sylvester window is decorative and favors repetitive forms.17 Three quatrefoils mark the central axis of the window, where two similar basins are represented. One is destined for the blood of the innocent children to cure the emperor, while the one above shows the baptism of Constantine. It is difficult to judge whether this very deliberate juxtaposition of water and blood carried further symbolic meaning directed against the Cathars’ heretical cult.

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Fig. 6.4  Prefect Tarquinius Interrogating St. Sylvester, 1322. Detail of Legend of Sylvester, Constantine, and Helena. Fresco cycle, Hohe Domkirche St. Peter und Maria, Cologne. (Image courtesy of Dombauarchive, Köln, Matz und Schenk.)

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In contrast to the Christological cycles discussed in chapter 5, most Sylvester images appear in spaces reserved exclusively for popes, the Curia, and/or the clergy; the narrative contents also refer to a variety of pressing contemporary issues. Leprosy gave the depiction of the legend a sense of grim reality that carried over into the other symbolic messages, yet there is no indication that these churches were in any way associated with leprosaria or even a hospital. Thus the ancient disease becomes a power symbol of the popes. The subjects do not relate to the plight of common leprosy victims—which was probably one of the reasons St. Sylvester did not feature prominently as a titular saint of lazar houses. To the contrary, most cycles made commentaries on historic events and reflected the power struggle, relating to papal supremacy over the might of secular rulers, in the guise of religious imagery. Needless to say, one of the major political issues of the High Middle Ages was the question of who would dominate the various regions on the Italian peninsula. Above all, the representation of the Sylvester/Constantine legend as a historical allegory is rare, if not unique, in religious art of the Latin West in the medieval period, which instead made veiled references to important contemporary political issues by connecting them to biblical or even classical figures and related symbolisms.

St. Peregrinus The Miracle of the Leprous Pilgrim Although less political than the legend of St. Sylvester, the legendary miracle of the leprous pilgrim involved secular rulers and the Abbey of St. Denis, the burial place of the French kings. The myth suggests that the illustrious church was consecrated by none other than Christ himself. In order to give the legend authority, it also involved the miraculous cure of a leprous man who was later associated with the popular, yet legendary, St. Peregrinus. The Missal of St. Denis was probably a gift from a member of the royal house to the monastery. The folio of the Leprous Pilgrim, dated 1350–51, recounts the story in three parts. First, the pilgrim appears in church on the eve of the consecration. Following conservative workshop practices, his symptoms are rendered as dotted facial blemishes. A voluminous outfit covers the afflicted, thus characterizing him as a leprous person. Hidden in a corner, the pilgrim witnesses Christ blessing the altar. Two angels and St. Denis, as well as SS. Peter and Paul, accompany

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the Redeemer. Because the requirement of the page’s text hinders the layout, the next two scenes cannot be read from left to right. In the lower right margin, Christ meets the pilgrim after the consecration and charges him to announce to King Dagobert I (first half of the seventh century) not to repeat the ceremony the next day. To give credence to the message, Jesus heals the sick pilgrim by pulling the festering skin from the man’s face. The third and final episode of the legend is painted in the left-hand corner. The scene takes place in front of the church and displays the cured man delivering the divine words while kneeling before the king, the bishop, and the clergy of St. Denis. As proof of the accuracy of his account, the pilgrim, now wearing courtly attire, presents to his illustrious audience his frightening “leper’s mask” placed on a large white sheet. Once he was cured, the man’s demeanor immediately changed from that of an insecure, humble pilgrim to that of a dashing courtier, reclaiming his former place in society. This second example of before and after scenes depicted here in two details (fig. 6.5) of the missal page is also of importance in showing how leprosy victims were perceived and illustrated.18 Popular in northern France beginning in the twelfth century, the legend of St. Peregrinus flourished in St. Denis until the French Revolution and may even have survived in some form in England. According to Rawcliffe, in another version of the legend, Christ placed the leprous face like a stone death mask on a pillar.19 Such stories are reminiscent of the carved Leper Head in Lincoln Cathedral or the Melton Mowbray Leper Head (both date roughly to the thirteenth century).20 It seems probable that the mask legend of St. Peregrinus, or possibly even a similar account featuring another saint, provides the key to these isolated and mysterious leprous heads in English cathedral sculpture. As centuries passed, overtly political subjects vanished from church decorations, and renderings of saints’ lives replaced these topics of political theology. Although leprosy apparently declined in the fourteenth century, interest in leprosy topics in the visual arts continued for several hundred years, mostly because there was a high demand for ornate church altarpieces, didactic murals, and illuminated manuscripts favoring leprosy saints. Although the political reasons become less obvious, they are indeed quite frequently responsible for the underlying motif of depicting a very select group of intercessors. The gentle

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Fig. 6.5  Two scenes from St. Peregrinus, the Leprous Pilgrim, 1350–51, book illumination. Manuscript page from the Missal of St. Denis, fol. 256v. (Image © V&A Images/Victoria and Albert Museum, London.)

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St. Elizabeth, the Clara Barton of her day, became the most commonly portrayed patron saint of leprosy.

St. Elizabeth of Hungary/ἀ uringia (1207–1231) Because St. Elizabeth was a princess of the House of Arpad, which ruled Hungary from 895 to 1301, the visual evidence of her veneration is most often found in and around the former kingdom of Hungary as well as in Germanic regions, where the saint’s magnanimity during the famine of 1226 is celebrated in religious art. In contrast, as already discussed in chapter 3 (see pp. 60–62), art of the eastern regions of Europe thoroughly explored the medical aspects of the saint’s work. The cathedral of Košice, Slovakia, was dedicated to St. Elizabeth, and its gothic high altar was painted by the Master of the Legend of St. Elizabeth in 1474–77. The polyptych contains no fewer than eight wings, displaying altogether forty-eight small painted panels in gothic frames. Twelve individual scenes are dedicated to St. Elizabeth’s life, six to each side wing, so that when the altar is fully opened, Elizabeth’s life is presented from the cradle to her death,21 and the core of the carved gothic altar is revealed, showing three large polychromed female statues. In the center is Madonna and Child; on the viewer’s right is St. Elizabeth of Hungary/ Thuringia, and on the viewer’s left is Elizabeth, mother of John the Baptist. The Arpadian saint’s cycle is juxtaposed with the life of the Virgin visible on the outer wings of the polyptych; scenes of Christ’s Passion complete this elaborate program. Several of the panels display leprosy topics. St. Elizabeth Bathes a Leprosy Patient (see fig. 3.4, p. 61) renders a complex composition of a deep view into a vaulted hospital space. Such representations are of great value to modern viewers because they supply information about the ideal of how fifteenth-century people should treat the leprous population. In this depiction of the leprosy ward, one of the male patients is submerged in a circular wooden container filled with water. The haloed St. Elizabeth gently places her hand on the patient’s head; the mood is almost sacramental. Even the tub resembles in shape and meaning the baptismal fonts so frequently seen in the Sylvester legend, emphasizing the analogy between the healing of disease and the cleansing of sin; the sacrament of baptism was frequently associated with leprosy. Even if the depiction of the leprosarium, with its minute description of the patients’ different stages of deteriorating health, reminds the modern observer of a genre

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scene (recording daily occurrences) of a hospital, the content of the panel emphasizes the good deeds of St. Elizabeth. The whole scene advocates compassion toward leprosy victims, who are painted with clinical objectivity, yet the afflicted, as individuals, remain strangely remote from the viewer. St. Elizabeth Bathing a Leprosy Patient also depicts a simple altar along the left wall of the sickroom; on the altar is a small sculpture group with Mary Magdalene holding her ointment jar, standing below a crucifix. The repentant sinner represents penance, which the church considered the appropriate response for the inmates of lazar houses.22 The Third Lateran Council guaranteed the observation of a religious life in leprosy hospitals; still, it is difficult to reconstruct the level or type of support the leprous population actually received. A bubonic plague scene, St. Aloysius of Gonzaga (?) Administering the Viaticum to a Plague Victim (figs. 3.1, p. 54) dated to the first quarter of the eighteenth century, helps elucidate the distinction in attitudes toward the two diseases. A leprosy victim’s condition was regarded as resulting from individual sinfulness, while victims of plague were seen as suffering collectively for a sinful community. Until the eighteenth century, the Catholic Church blamed such epidemics on the transgressions of the community; thus, cities responded to plague epidemics collectively and tried to make amends to the Lord by pledging churches, liturgical objects, altar paintings, and much more. The large altarpiece places the viewer within the environment of a makeshift plague hospital; the background is filled with patients (fig. 3.1, p. 54). In the foreground, the scene dramatically introduces the viewer to personal tragedies such as the dying mother with a child on her lap; supported by a fatherly figure, she receives her last communion before she enters the hospital. Although the image is dated more than two centuries later than the St. Elizabeth altar, each altarpiece is typical of the iconographic conventions of leprosy and plague. The scenes from the plague altarpiece introduce the viewer to individual personalities; the dying mother, the fallen monk, and the stricken grave-digger, to name a few professions, all will be torn from their daily lives by the plague—similar to the Dance of Death tradition.23 In contrast, leprosy patients are defined by the curse of their illness. The imagery portrays the infected victims as completely isolated from families and having lost their place in society. With no hope for a cure, they can only aspire to a better life in the next world.24

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The cult of St. Elizabeth inspired countless other carved altarpieces illustrating charming vignettes of the saint’s brief yet very effective life. For example, the Holy Kinship altar, Smrecany, Slovakia (formerly the kingdom of Hungary), dated 1510, is dedicated to Christ’s extended family. The program of the early sixteenth-century triptych is worth mentioning for its timely subjects. When the altar is closed, four oblong panels are seen, all dedicated to St. Elizabeth’s life. The first episode on the far left (immovable panel) ties in with the Christological motif, showing the saint’s unrestrained dedication to the cause of the stricken. Placing a Leper in Her Husband’s Bed (fig. 6.6) depicts the moment in the story when the Margrave of Thuringia uncovers a crucified Christ, in lieu of the sick man, in his bed. This legendary event may trace its roots to the homilies of Gregory the Great, who described Christ’s appearance after his Passion as “quasi leprosus.” The image of the crucified Christ is shown on a dark cover, creating a tomblike effect. On the right, the margrave kneels in adoration of the Lord. At the head of the bed, Elizabeth stands with her arms piously crossed, emphasizing her faith and the two witnesses required to authenticate the miracle express their amazement. The painting’s message to the faithful—not specifically addressing leprosy patients—was intended to inspire charity, compassion, as well as humility, self-denial, and, above all, faith. The two movable center wings show, on the panel adjoining the miracle, St. Elizabeth’s Eviction from the Wartburg (fig. 6.7). Because the princess was far from her royal family in Hungary after her husband’s sudden death, the widow and her children suffered much in the foreign land. Another section of the altarpiece recounts the episode of the story in the Golden Legend in which the saint cuts the hair of her patient; this time the patient prays in the tub while Elizabeth ministers to his needs in an effort to relieve his suffering. The far right (immovable panel) depicts St. Elizabeth’s Deathbed, which is likened to the Death of the Virgin as an angel carries her soul to heaven. When the altarpiece is open, the interior view in the center portrays St. Anne with the Virgin and Child; behind them are the male members of the extended family. The movable side wings, left and right, introduce the rest of Christ’s family, a subject particularly popular around 1500. All three panels are painted against a richly embossed gold background. A contemporary triptych (1516) created in the German region by Hans Holbein the Elder (ca. 1465–1524) also depicted St. Elizabeth

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Fig. 6.6  St. Elizabeth Placing a Leper in Her Husband’s Bed, detail of Holy Kinship Altar, 1516? Painted panel. (Photograph courtesy of Smrecany Church, Smrecany, Slovakia.)

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Fig. 6.7  St. Elizabeth’s Eviction from Wartburg (left) and St. Elizabeth Bathes a Leprous Patient (right). Details of Holy Kinship Altar, 1516? Painted panel. (Image courtesy of Smrecany Church, Smrecany, Slovakia.)

(fig. 6.8). The original site of this famous Sebastian’s Altar (now in the Alte Pinakothek, Munich) and the identity of the donor are unknown. Holbein’s altar has been claimed by both the St. Sebastian’s and the St. Catherine’s churches in Augsburg. The center panel depicts St. Sebastian, who was petitioned against the plague; the left wing depicts St. Barbara, renowned as an intercessor for a good death; and the right wing depicts St. Elizabeth, who is most commonly associated with patients of leprosy. Similar triptychs with programs featuring thaumaturgical saints were common in the early sixteenth century.24 Such altars were commissioned in the hope that a pious donation to the church would prevent future epidemics and unexpected deaths, and offer succor to the sick.

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Fig. 6.8  Hans Holbein the Elder (1465?–1524). St. Elizabeth with ἀ ree Male Petitioners. 1516, painted panel. Right wing, Sebastian’s Altar. (Image courtesy of Bayerische Staatsgemäldesammlung and Alte Pinakothek, Munich.)

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None of these St. Elizabeth altars was dedicated solely to a leprosy scene, nor was any placed in a leprosy chapel. Unusual, however, is the personal appearance of the Holbein family in the context of leprosy; they appear on the right inner wing, St. Elizabeth Surrounded by ἀ ree Male Petitioners (fig. 6.8). Like the three stages of man, the altar depicts, to the saint’s right, a boy marked with skin blemishes holding a bowl, possibly a gift from the generous saint. An old man kneels on Elizabeth’s left, receiving either medicine or a drink in his container; his face and arms give some indications that he may be infected with leprosy. Behind him appears a bearded middleaged man in a praying position. Based on a signed Holbein drawing, the bearded man has been identified as a self-portrait of the painter, who was a pioneer north of the Alps in the art of sketching figures from life. The 2006 museum catalogue identifies the leprous child as the artist’s son, Hans Holbein the Younger.25 To complicate the state of affairs further, a certain Rudolf Virchov saw a St. Elizabeth panel in a gallery in Augsburg, apparently in 1861, and wrote about his impressions. More than a hundred years later, two physicians found his account in a nineteenth-century medical archive in Berlin and published a translation, “A Painting of Lepers by Hans Holbein the Elder,” in the American Journal of Dermatology. Virchov’s description of the three (or more?) leprous persons in the St. Elizabeth panel is not identical with what we now see in Munich. Nevertheless, Virchov’s positive assessment of Holbein’s clinical details is informative: “These are exactly the features of the disease as it is seen today in such numbers in the hospitals in Norway.”26 Until more is learned about the commission and the panel in Augsburg, it is impossible to draw conclusions regarding how this preparatory panel is related to the Munich altarpiece and about Holbein the Elder’s intentions. An eighteenth-century fresco, certainly one of the latest examples focused on a leprosy topic, can be found in Komin (Serbia), where an older sanctuary was rebuilt in 1720 only two years after the Peace of Passarowitz (Serbia) adjusted the borders of the Ottoman Empire.27 The chapel added in 1731 was dedicated to St. Elizabeth and decorated with a fresco, St. Elizabeth of Hungary Dispensing Medicine to a Leprous Beggar. According to S. Farovic-Ferencic and T. Buklijas, no records of leprosy cases exist in that particular region for that time. Moreover, in the mural, the wounds of the afflicted are not identifiable as those of a

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leprous person.28 This indicates that Hansen’s disease was no longer a threat and that the figure of a leprous beggar was reduced to the customary attribute of the national heroine (see fig. 4.8, p. 86). Presumably the image paid homage to the Hungarian saint in an effort to ease the growing nationalistic tensions in the Habsburg satellite states. Of equal importance is the rush to rebuild churches and supply them with religious imagery to combat the iconoclastic tendencies of the neighboring Muslim empire and the increasing Protestant population in the eastern provinces of the Habsburg Empire. Reviewed superficially, the later religious leprosy subjects seem less oriented toward political theology. However, one has to recognize the choice of saints, such as Elizabeth of Hungary, Martin, Peregrinus, and others, as reflecting specific dynastic and nationalistic, as well as religious concerns.29 E  E  E While a great deal is known about the saints, the role leprosy patients played in the arts is more difficult to evaluate. Generally speaking, the images advocate compassion toward the leprosy patients, though the individuals remain somewhat subdued. In biblical illustrations, with the exception of Naaman (because he was not a Hebrew), the victims are uniformly shown wearing “rent” garments. Institutionalized leprosy inmates are later depicted as bedridden patients, members of lay orders, or beggars, as demanded by society, the church, or their state of health. They were believed to suffer for their own sins or those of other peoples, but in all the works we have studied, we have seen only two cured patients portrayed before and after the miracle occurred. In both instances, the men were healed by the grace of Christ (figs. 2.7, p. 36, and 6.4) and both victims, after they regained their health, were presented no longer as beggars but as honored members of society. In the Middle Ages—and even later—the characterization of the earthly persona was perceived as being of great importance not only for this life but also in the hereafter. Some of these characterizing features seem to be curiously missing in the portrayal of anonymous leprosy victims. They patiently shared a common destiny of suffering in isolation for years presumably hoping that their illness was the purgatory and salvation of their souls, as Guy de Chauliac promised his wards.30

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From the fifteenth to the seventeenth centuries, leprosy subjects became increasingly rare and a change in attitudes toward the leprous population becomes noticeable. Even if some of the subjects, as in previous centuries, were based on religious texts, the artists are granted greater freedom in their interpretations. Despite increasing realism in style, the interpretation of the content becomes more challenging because readability was no longer a primary concern. Topics of leprosy also served more diverse functions in society, and artists depicted a few more subjects of a secular nature.

Chapter 7

Diversity in Leprosy Subjects

Biblical ἀ emes and Increasing Secularization ca. 1450–1750 Biblical Subjects

Similar to the process of interpreting the Christological topics, the images portraying legends involving a leprosy topic also needed to be studied primarily with their immediate historical and theological background in mind. These patterns changed with the beginning of the early modern period when leprosy started to wane except in Europe’s northernmost regions. By 1500, urbanization had brought new challenges and new illnesses that overshadowed the effect of leprosy. Other diseases occupied people’s minds and bodies; for example, bubonic plague (from 1347), syphilis, tuberculosis, and ergotism (St. Anthony’s Fire). Poverty was rampant. Depressed economic conditions produced an ever-growing population of urban destitute. Even worse off were the itinerant poor, whether they were sick or well (on the plight of the unfortunates in Nürnberg’s broadsheet of 1493, see p. 26; fig. 2.2, p. 27). Conditions became so dire that in the 1570s, roughly three thousand people gathered for Nürnberg’s annual leprosy examination in the hope of obtaining a begging license, and in 1575 around seven hundred were denied the privilege.1 The tide had turned: instead of concealing their leprosy infections, some beggars tried to counterfeit them. During this period, religious reform movements and phenomenal artistic innovations dominated the era. Only a few—albeit more complex—leprosy subjects were painted in Italy and the Netherlands, the two regions that excelled in progressive styles since the early Renaissance. The discussion here focuses on a few well-documented masterpieces and several lesser works that, while depicting leprosy, are diverse in subject matter, medium, and function. 131

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Christ Healing a Leper by Cosimo Rosselli (1439–1507), in the Sistine Chapel, Rome, is a rare subject in Italian monumental art. In 1481 Pope Sixtus IV (1471–84) summoned to Rome the Umbrian painter Cosimo Rosselli, along with Botticelli, Ghirlandaio, Signorelli, and Perugino—the most admired Italian artists of their generation—to decorate the newly constructed Sistine Chapel (ca. 1477–80). It may surprise the modern reader to know that it was Rosselli, among his famous peers, who won the papal commission’s first prize for his four religious paintings.2 The pontiff who founded this world-renowned building, Francesco Della Rovere, was an astute scholar and theologian, and had been elected general of the Franciscan order and cardinal of San Pietro in Vincoli before he was elevated to St. Peter’s throne. Pope Sixtus IV’s personality, as ample research proves, must be considered a key factor in these erudite quattrocento decorations. He could be called the first of the Renaissance Princes in the Eternal City. He renovated Rome, rebuilt its walls, and supported the Vatican library. Undoubtedly, his most famous achievement was the creation of the Sistina, in part intended to celebrate the one hundredth anniversary of the Roman popes’ return from Avignon, often referred to as the papal Babylonian exile. It also commemorated the improvement of the tense political situation that arose after 1377 when Pope Gregory XI (1329–78) first took up residence in the Vatican, a period followed gradually by an increase of papal influence and power. Before delving into an analysis of Rosselli’s Christ Healing a Leper (fig. 7.1), the erudite program depicting cycles from the Old and New Testaments that still graces the walls of the chapel merits an introduction. Countless art historians have already discussed the iconological interpretations of the fifteenth-century Christ and Moses series. Since this investigation is limited to the leprosy subject, L. Ettlinger’s ἀ e Sistine Chapel before Michelangelo: Religious Imagery and Papal Primacy and C. Lewine’s ἀ e Sistine Chapel Walls and the Roman Liturgy form the basis for the discourse.3 The latter author builds her arguments logically on the excellent scholarship of her predecessors, yet adds a whole new dimension to hitherto unresolved issues. Lewine’s investigations answered convincingly many questions ignored in previous literature; for example, why certain unusual subjects were included in the murals of this illustrious papal place of worship. She summarized the intrinsic meaning of the history paintings as a design to promote papal primacy

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Fig. 7.1  Cosimo Rosselli (1439–1507), Christ Healing a Leper, detail of ἀ e Sermon on the Mount, 1481. Fresco, Sistine Chapel, Vatican Palace, Vatican State. (Image courtesy of Alinari/Art Resource, NY.)

and to provide Franciscan elements along with biographical, chronological, typological, and liturgical sequences (her most important contribution). In seeking a rational premise as to why this leprosy topic was chosen, Lewine found answers in the Roman liturgy.4 Although I can only briefly touch on the juxtaposition of the Old and New Testaments, the mural’s theological complexity should not be underestimated. Consisting originally of sixteen framed scenes, rare in subject matter and stylistic achievements, the frescoes were designed for the space reserved for popes, the Curia, conclaves, and important political visitors. Scenes from the life of Jesus originally showed the Nativity of Christ by Perugino (before Michelangelo covered the western altar wall with his Last Judgment). On the north wall are six large framed panels presented chronologically and in continuous narrative: ἀ e Baptism of Christ, St. John Preaching by the Jordan, and Christ Preaching (Perugino); ἀ e Temptation of Christ and Jewish Sacrifice (Botticelli); ἀ e Calling of the First Apostles (Ghirlandaio); ἀ e Sermon on the Mount, Christ Healing a Leper (Rosselli); ἀ e Gift of the Keys, ἀ e Tribute Money, and ἀe

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Stoning of Christ (Perugino); ἀ e Last Supper, ἀ e Agony in the Garden, ἀ e Betrayal, and ἀ e Crucifixion (Rosselli); and on the entrance wall, ἀ e Resurrection and ἀ e Ascension (Ghirlandaio). The opposite side portrays the life of Moses, starting originally on the altar wall with ἀe Birth of Moses (now lost). On the south wall are ἀ e Circumcision of Moses’ Son (Perugino-Pinturicchio); Moses in Egypt and Midian (Botticelli); ἀ e Crossing of the Red Sea and ἀ e Song of Moses (Rosselli); ἀe Lawgiving on Sinai and ἀ e Adoration of the Golden Calf (Rosselli); ἀe Punishment of Korah and the Sons of Aaron and ἀ e Stoning of Moses (Botticelli); ἀ e Last Testament and Death of Moses (Signorelli); and on the entrance wall, ἀ e Fight over the Body of Moses (Signorelli).5 Rosselli’s Christ Healing a Leper (Matt. 8:1–4) was included in the foreground of ἀ e Sermon on the Mount (Matt. 5–7) and constituted the only miracle portrayed in either of the cycles. Divided into a number of subscenes pertaining to Christ’s teaching and the institution of the law, the painting depicts a splendid hilly landscape. On the right-hand side of the fresco, Jesus is returning from the mountain when a leprous man petitions him to be cleansed. Their eyes meet as the afflicted lifts his head pleadingly toward the Savior, who replies, “Be cured!” Wearing only a loincloth, the young man’s body is covered with reddish brown spots; however, the victim’s face appears unblemished (see fig. 7.2). Does this signify that the healing process has already begun? Thomas Aquinas (1225–74) proposed that miracles, like the natural healing process, do not happen instantaneously.6 The only indication that such a change may be taking place is provided by a fatherly figure who stands rigidly behind the kneeling sick youth, staring wide-eyed and completely mesmerized at Christ. His hand gesture and body language also indicate surprise, thus bearing witness to this miraculous occasion. The rest of the bystanders observe the event solemnly but without emotion; they seem unaware of the miracle in progress. The gilded superscript heading of ἀ e Sermon on the Mount, “Promulgatio Evangelicae Legis per Christum,” is echoed across the nave in ἀ e Lawgiving on Sinai; its titulus reads “Promulgatio Legis Scripte per Moisem,” thus activating the space between the two walls with messages pertaining to the written Law of Moses and Christ’s evangelical teachings. The typological ideas are meant to project a parallel construct between Moses and Christ, as both being “priest, king, and

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Fig. 7.2  Comparison of details from Christ Healing a Leper, from Gospel Book of Otto III, ca. 1000 (fig. 2.6), and Rosselli, ἀ e Sermon on the Mount, 1481 (fig. 7.1).

lawgiver.”7 The importance of the priesthood, for the papacy, is obvious; however, the papal duties as temporal rulers were often challenged. How does Rosselli’s leprosy painting differ from the scenes in the Christological medieval cycles discussed in chapter 5? The Renaissance leprosy scene seems no longer to respond to the real threat of the illness, as was the case in earlier depictions of Christ healing a leper. In comparing the Ottonian victim (fig. 2.6, p. 34) with Rosselli’s portrayal (fig. 7.1), one observes that the earlier work displays innovative clinical observations. The eleventh-century book illumination presents specific manifestations of HD (i.e., hair loss and loss of voice). Instead, the early Renaissance master presents a classical seminude youth, making no attempt to characterize authentic medical symptoms. Although the spots on the Sistina’s victim may appear believable as any number of skin

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rashes, they do not portray lepromatous or tuberculoid leprosy. Apart from the enormous differences in style, the images are comparable in meaning by expressing differences between the harsh laws of the Old Covenant and those of the New. Christ’s miracles, however, are no longer the main focus; appropriately for the frescoes in the papal domain, the paintings emphasize Christ’s ministry. Unlike earlier examples whose patrons were medieval secular rulers, the patron for these works was a reigning Renaissance pope. In the Sistine Chapel, an intricate theology had replaced the Christological ideology of the Ottonian and Norman productions. The learned audiences of the Vatican appreciated the sophisticated innuendoes presented in the typological imagery, in all details, as they heard famous preachers expounding them in exegetical sermons.8 Rosselli’s blemishes are stylized; they are meant to facilitate a symbolic reading of the image. The two consecutive events in Matthew, Christ healing a leper after the Sermon on the Mount, had also become a theological topic. The famous philosopher and theologian Hugh of St. Victor (1096–1141) discussed the sequence by referring to the victim as the representative of all mankind whose sins had been washed away by Christ’s sacrifice on the cross.9 We do not know if Rosselli referred to these ideas specifically; however, the artist seems to imply universal suffering healed by a compassionate Savior, who according to Roman Catholic theology, is the only mediator between God and mankind. The victim appears to be a worthy human being. The only indication for the viewer that the miracle is already in progress is the dramatic reaction of the fatherly figure and the missing blemishes in the supplicant’s face while the rest of the body still carries the marks of leprosy. Rosselli’s mural is a perfect example of a metaphorical interpretation of a miracle. The Sermon on the Mount was rarely depicted in Italian monumental art and even less often combined with the healing of a leper, yet both subjects feature prominently in the Sistine Chapel, demonstrationg how humanist idealization dominated southern Renaissance production. In contrast to their Italian colleagues, Netherlandish artists emphasized realism in their clinical descriptions of leprosy. Oil painting was the preferred medium in the Netherlands, and artistic depictions of leprosy served very different functions in society than the monumental decorations in the papal sanctuary. The charmingly intimate ca. 1524 Naaman Triptych (fig. 7.3) by Cornelis

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Fig. 7.3  Cornelis Engebrechtsz (ca. 1465–1527), Naaman Triptych, 1524, painted panel. (Image courtesy of Kunsthistorisches Museum, Vienna.)

Engebrechtsz (ca. 1468–1533) at first glance appears to be very traditionally and symmetrically organized. When the altarpiece is closed, one sees two thaumaturgical saints, Cosmos and Damian, who dominate the outer wings (fig. 7.4). They are characterized as physicians displaying their medical implements. These two early Christian saints wear matching knotted ribbons on their hats, although the meaning of their adornment remains unknown. Contrary to the viewer’s first impression, however, Walter S. Gibson asserts that the triptych is most fascinating for its “unusual combination of subject matter.”10 In the opened triptych, a single scene unifies the beautiful landscape spread out over the three panels. The images adhere closely to the text of 2 Kings 5:1–27. The story weaves in and out through the mountainous terrain, recounting Naaman’s trip from Syria seeking help from the Hebrew prophet Elisha, his return as a cured man, and all the events in between, which are described in detail in the Old Testament. The action unfolds before our eyes in small background vignettes; the viewer has to follow the visual threads to make the account come alive.

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Fig. 7.4  Cornelis Engebrechtsz (ca. 1465–1527), SS. Cosmos and Damian, 1524, painted panel. Outer wings of Naaman Triptych (fig. 7.3). (Image courtesy of Kunsthistorisches Museum, Vienna.)

As customary in northern Mannerist paintings, the scenes are randomly integrated into the landscape; the introduction of a secondary scene or a trope is frequently indicated by figures presented in different scales, signifying that unification of time, place, and action, is suspended. Nor can we read scale as hierarchical. For example, the prophet Elisha, the most renowned figure in this work, is never depicted larger than about an inch high (most likely to keep the holy man hidden from the observer’s gaze unless considerable time and effort are spent singling him out). These deliberate breaks with artistic conventions in the 1520s were intended to challenge viewers to participate in solving the visual puzzle and interpreting correctly the multilayered narrative.11

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The center panel focuses on Naaman’s cure in the Jordan, placed prominently in the foreground. The once leprous Syrian general stands nude, knee deep in the Jordan, his skin unblemished. His flowing hair and bearded face emphasize an analogy to Christ’s baptism, though Naaman’s contorted stance and his hand gestures are markedly different and cannot be mistaken for the baptized Jesus.12 On the right bank of the river stands an attendant holding the general’s gold-embroidered clothes; the left bank, shaped like an arrow, points to the main event— the cure. Naaman’s entourage and the figure of a court jester share the embankment; he appears right behind Naaman standing in the Jordan. Ruth Mellinkoff associates the fool’s costume with a nonbeliever, citing Psalms 13:5 and 52:53, both of which begin with the words “The fool has said in his heart: ‘There is no God.’” Mellinkoff emphasizes the fool stick in the jester’s hand, though she cautions that the depiction may be more or less unique in the Naaman iconography.13 Gibson identified most of the scenes; the secondary episodes of the story are portrayed as tiny, figurative tableaux. The visualization of the narrative begins with Naaman’s attempted visit to Elisha on the upper right of the main panel, where a servant sent by the master, possibly Gehazi, delivers the prophet’s instructions; he seems to be pointing toward the Jordan. According the second book of Kings, the general took offense that the man of God did not present himself in person, and the angry Naaman was about to depart without accomplishing his mission. The Bible also tells us that one of his loyal servants convinced Naaman to follow the prophet’s advice. The Syrian general’s change of heart is not illustrated in the background; the reason for omitting Naaman’s new spiritual awareness follows later in this discussion. Undeniably, Naaman’s cure in the Jordan takes center stage. We pick up the thread of the story after the Jordan scene, in a small vignette on the right, with the road leading to Elisha’s house. A domed towerlike structure (a symbol of the temple?) becomes visible above Naaman’s head in the foreground. To the viewer’s right is the small background scene of the Syrian general meeting Elisha. The prophet, wearing an impressive headdress, presents himself to the healed Naaman, who kneels offering thanks and gifts to the holy man. The Syrian also professes that he will no longer offer holocaust (burnt offerings) to any god other than that of Israel. Still, Elisha refuses to accept the opulent gifts Naaman provides in gratitude for restoring his health. A few paces

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behind Elisha, Gehazi appears and seems to overhear the conversation between his master and the Syrian. Gehazi plays a major role in the Old Testament account and possibly in the triptych as well. On the left-hand side of the central panel’s middle ground, one can observe Gehazi following the train with the rejected treasures. Eventually, pretending to be sent by Elisha, Gehazi asks for some of the presents. Naaman gladly complies and selects bushels of silver and two festal garments, which Gehazi and his helpers receive and take back to the prophet’s house. Several men loaded down with heavy bags approach the left entrance of the prophet’s monumental home; there the greedy servant hides them from the holy man (not shown). On the right side wing of the altar (fig. 7.5) at the very top above the seated man, Elisha confronts Gehazi about his lies and dismisses him with the words: “ ‘The leprosy of Naaman shall cling to you and your descendants forever.’ And Gehazi left Elisha, a leper white as snow” (2 Kings 5:27).14 The question presents itself: Why is Gehazi not shown as a leprous person in that scene to drive home the message of the Lord’s punishment? As mentioned earlier, a second very important scene—Naaman’s conversion—is also missing from the background narration. On the far left of the central panel we see Naaman and his retinue traveling to a distant land, vanishing over the horizon and reappearing in the distance on the left inner wing. High up in a rocky landscape, in front of a fortified town, we witness Naaman’s joyous return to his wife and her maidservant. It was this Hebrew slave who, at the opening of the biblical chapter, made it known that the only person who could cure the master was the prophet in her homeland. So far the account is quite clear, yet two large unidentified figures, represented on the same scale as Naaman in the Jordan, occupy prime spaces in the intricate composition and present an enigma. The two men in question are seated on the left and on the right of the inside altar panels. Are they part of the story told in scripture? Compared to the isolated figures of saints Cosmos and Damian on the outside, who stand like statues on pedestals, these figures appear to be a part of Naaman’s retinue. Gibson merely refers to them as “a pair of soldiers … whose poses mirror each other” (figs. 7.5, 7.6).15 My attempts to identify them more specifically in the museum’s file, the gallery’s catalogues, or on museum labels were fruitless. Are they really just nameless soldiers? They are clearly intended as pendants. It seems likely that the artist meant the viewer to identify the two figures by their unusual physical appearances.

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Fig. 7.5  Cornelis Engebrechtsz (ca. 1465– 1527), Soldier[?]: ἀ e Leprous Naaman, 1524, painted panel. Detail of Naaman Triptych (fig. 7.3). (Image courtesy of Kunsthistorisches Museum, Vienna.)

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Fig. 7.6  Cornelis Engebrechtsz (ca. 1465–1527), Soldier[?]: ἀ e Leprous Gehazi, 1524, painted panel. Detail of Naaman Triptych (fig. 7.3). (Image courtesy of Kunsthistorisches Museum, Vienna.)

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Dermatologist William H. Ober, in his innovative 1983 article, “Can the Leper Change His Spots?” described the man on the left: “whose face is asymmetrical with left maxillofacial swelling and distortion of the left orbit, perhaps a leper being told of [a] possible cure.”16 Ober did not search beyond the dermatological signs or he might have noticed the anomalies in the figure on the right. I suggest that the person on the right wing is a portrayal of the “leprous” Naaman. This man and the Syrian general in the Jordan present similar profiles (Engebrechtsz’s workshop operated primarily with stereotypes). In addition, several comparisons gleaned from medical literature and symptoms depicted in other historic leprosy imagery provide further evidence of this figure’s impaired state of health. Although the man on the right is well dressed, his lower legs show unusual leggings. His swollen knees—one is even exposed—remind us of frequently depicted joint deformations of leprosy patients and need to be compared with images of other leprous persons (see figs. 3.3, p. 58; 3.5, p. 63; 4.7, p. 84; and 4.9, p. 88).17 The so-called soldier’s lance is placed upside down and seems to serve the man better as a cane than as a weapon (the reversal of the shaft would diminish the power symbol). If this figure is Naaman before his cure, it would not be surprising that his long hair and beard are missing. Loss of facial hair is an indication of leprosy and we have already observed similar changes on the victim in Christ Healing a Leper in Ottonian book illuminations (see fig. 2.7, p. 36). The foreground scene may then recount the moment when Naaman is being persuaded by his servant to follow Elisha’s advice to cleanse himself of the disease in the waters of the Jordan, the important event—the classical turning point of the story—missing in the background narrative. If this is the case, one can identify the second man in the panel who leans over Naaman’s shoulder as his trusted advisor. Both men are turning toward the river. Possibly the artist wanted the viewer to focus on Naaman’s conversion, necessary for his healing process. The Syrian general’s conversion to Judaism is emphasized in the Old Testament as adopting the faith in the only “true” God. Even more puzzling is the seated man on the opposite wing. He resembles even less a traditional soldier because he wears civilian clothing and has no weapons in sight. Moreover, his face is swollen, and he appears indolent with his staring “round eyes” considered then in medical literature as univocal signs of leprosy and his bulbous nose.

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The seemingly rich man, however, also wears a large bronze bell—one of the required warning signs of the leprous—sewn onto his cape. Is he infected with leprosy? It is noteworthy that neither he nor the man behind him (a pagan physician?) is looking at the miraculous cure of Naaman in the center; they seem self-absorbed. Indeed, the seated man points tentatively at his deformed hand (in particular the swollen thumb muscle of his inner palm, an equivocal sign).18 The message conveyed to the attentive viewer is that the person is unsure of the state of his health. Because he is visually aligned with the fool in the center panel, whom Mellinkoff identifies as an “unbeliever,” I would propose that this figure represents the sinner Gehazi. This would be the first close-up view of one of the major protagonists in Naaman’s tale, Elisha’s servant stricken with leprosy as punishment for his greed and his lies. He has the corpus delicti, his ill-gotten gift of festive garments with broad gold borders, draped over his knees. The moral of the biblical account is further underscored by the ironic placement of the presumed Gehazi, beneath the scene of the Syrian general’s happy return, while the heroic figure, whom I assume to be Naaman, is seated below the tiny scene where Elisha anounces Gehazi’s curse: “the leprosy of Naaman shall adhere to you, and to your offspring forever.” The two men are linked by their physical disabilities; the man of faith, who will be healed, is juxtaposed with the unbeliever. Thus the actions and attitudes of the two personalities can be compared and pondered by the faithful. When the wings of the altar are open, the two leprous figures present a visual sermon. They frame the main event: Naaman’s Cure. Although these assumptions may seem less obvious to the present-day observer, one must consider the function of the object and the sixteenth-century audience, who were attuned to biblical references. Gibson noted similar parallels when interpreting the altarpiece. He remarked that contemporary viewers should and would have observed analogies that are displayed in the Engebrechtsz triptych by noticing similarities in the characters of Elisha and SS. Cosmos and Damian (all three men refused payment for their God-given art of healing).19 One may also assume that at times when leprosy was endemic in Europe, these biblical names were familiar to the public (see discussion of the French Cagots, pp. 49–50). Both Gibson and Mellinkoff admit that the altar is unusual, even unique. Gibson most likely was not familiar with leprosy manifestations when he assumed that the “pair of soldiers” was the work of

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unskilled assistants.20 There are several reasons why it was more difficult in 1969 to identify their disfigured bodies as being infected with leprosy. Because Western countries, by that time, were free of Hansen’s disease, only doctors working in the Far East or Africa would have known about this ancient scourge. There were fewer medical handbooks available nor was the Internet known. Yet, more significant is that the twentieth-century art historians did not generally look to medicine as one of their supportive disciplines. For example, the famous art historian Anthony Blunt is on record as having told scholars of the Pasteur Institute that he was not interested in clinical details of bubonic plague. These oversights may be remedied in part in the twenty-first century with both advances in science and new approaches in art history. Gibson proposes that the triptych may have been painted for a guild of surgeons. Medical professionals would have appreciated its specificity in characterizing the manifestations of leprosy. Gibson also mentions that the altar may have originally been placed in a chapel for the brotherhood of SS. Cosmos and Damian; in that case the small altarpiece was probably displayed in an intimate space to facilitate the reading of this cryptic work of art at close range.21 For all the above reasons and because no similar altars were found in leprosaria, it is highly improbable that the Naaman triptych served in such a capacity. The subjects of the other examples in this chapter, possibly also depicting victims of leprosy, are even more challenging to identify. These works of art testify to new artistic inventions. For centuries, close adherence to the texts guaranteed a correct reading of the honored subjects based on scripture and famous legends. Because themes of leprosy were no longer based on specific literary sources, as was generally required of history paintings up to and through the High Renaissance, the works left room for speculation. The loss of visual traditions opened the door to innovative and tantalizing ambiguities for Mannerist artists, as can be observed in the oeuvre of the master of controversial and puzzling imagery Hieronymus Bosch (1450–1516). An enigmatic leprosy subject, not based on a written source, is represented on the right exterior wing (dimensions: 167 x 60 cm) of the Last Judgment Triptych (Akademie der bildenden Künste, Vienna). Attributed to Hieronymus Bosch and/or a follower (in his workshop?) and dated between 1504 and 1508 or possibly later, the work depicts St. Bavo Giving Alms to the Poor and Sick (fig. 7.7). St. Bavo (589–653/654)

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Fig. 7.7  Hieronymus Bosch (1450–1516). St. Bavo Giving Alms to the Poor and Sick, ca. 1504–8, painted panel. Right outer wing of Altar of the Last Judgment. (Image courtesy of Gemäldegalerie der Akademie der bildenden Künste, Vienna.)

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was the patron of Holland; he was most popular in the sixteenth and seventeenth centuries. This discussion of the program is based largely on the interpretation given by the gallery’s director, Renate Trnek, in the catalogue of the collection. When the triptych is open, the viewer sees Paradise on the left, yet the fall of the angels and the fall of man are highly visible, setting a very pessimistic tone. The center panel, Last Judgment, most prominently depicts the seven deadly sins as if they were the main subject. Christ the Judge is relegated to the distance, raising questions of “whether sinful mankind has any possibility of redemption at all.”22 Bosch’s inimitable fantastic design displays, on the right, Hell and the Prince of Darkness. Most Bosch scholars assume that the triptych is in some shape or form associated with the Last Judgment that Philip the Handsome of Burgundy (1478–1506) commissioned from Bosch in 1504, two years before the prince died. Philip was the son of the Holy Roman Emperor Maximilian and Mary of Burgundy. Several scholars have supported Dirk Bax’s theory that St. Bavo resembles contemporary portraits of Philip.23 The Flemish saint, in his slight build, elegant facial features, and long, slender nose, is difficult to categorize as an actual “portrait” of Philip, but rather seems to be a flattering portrayal of an aristocratic St. Bavo with features reminiscent of Bosch’s noble patron. The connection with the lost work is convincing when the whole program of the masterpiece is examined. Assuming that a similar triptych—although somewhat larger—was originally commissioned by Philip, also Count of Flanders, who had dynastic ties with Spain through his marriage with Joanna of Castile, the choice of SS. Bavo and James Major might allude to the ruler’s far-flung political influence. I found an additional link to the commission of Philip the Handsome in the recent exhibition The Art of Power: Royal Armor and Portraits from Imperial Spain, which included an almost contemporary full-length (close to life-size) portrayal of the famous ruler that presents an intriguingly similar quasi-contrapposto stance (in reverse) to that which St. Bavo strikes in the Vienna triptych. The portrait is attributed to the Netherlandish Master of the Joseph’s Sequence and dated ca. 1490–1506. The exhibition catalogue states that the panel belongs to yet another Last Judgment Triptych, which displayed Philip’s wife, Joanna, on the opposite outer wing. Also of interest is that the Brussels panels were created not for a church but for the Hôtel de Ville at Zierikzee, thus

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being similar in function to secular justice panels.24 However, it is futile to speculate further on the patron of the Vienna masterpiece, since the crests below SS. Bavo and James remained empty. The outer wings of Vienna’s Last Judgment are painted in grisailles; they represent on the right St. Bavo and on the left the apostle of Campostello St. James on Pilgrimage, which portrays the saint as a traditional Christian pilgrim with cockleshell and staff. Small background figures, committing vicious crimes, surround the large and idealized St. James; only his unshakeable faith in God allows him to continue his way “unmolested through this world where evil reigns.”25 The panel St. Bavo Giving Alms to the Poor and Sick is more difficult to interpret. The youthful nobleman wears spurs and carries a falcon, his attribute, on his left arm. He reaches with his right hand into his purse to produce a few coins to give to the needy assembled around him. These characters, however, make for a strange-looking lot! To the saint’s left appears a surreal family consisting of a bizarre old crone who carries a small, seminude boy on her shoulder while another little one stands by her side. The child riding on the woman’s back balances a porringer with spoon on his head. This group resembles figures in Bosch’s St. Anthony Triptych (Museo Nacional de Arte Antiga, Lisbon).26 Behind St. Bavo and on his right appears a hooded beggar, only partially visible, wearing a long-sleeved outfit designating him as a victim of leprosy. The man reveals a large wound (or plaster?) on his right arm (it is difficult to make out the details). In his left, he holds the characteristic leper’s bowl, recognizable by the official dangling lead seal. Although one cannot be absolutely certain that the man suffers from leprosy, several features indicate that the artist aimed to characterize the beggar as leprous. The man’s right hand is bent sharply at the wrist; however, in comparison with the photograph of the leprous woman’s crippled arm, also bent at a sharp angle, one can observe many differences (fig. 7.8). Most importantly, the beggar’s fingers are not disfigured and his face, which one would expect to be severely marred by lepromatous nodules, is also unaffected by the illness. His sly look as he ogles the saint’s purse while his thumb points downward to his alms bowl, makes his character suspect. Bosch’s beggar displays a detached “lower leg” on a square white cloth in front of him, but we are unable to see if it is actually the man’s own foot. Larry Silver suggests that the gangrened, amputated leg looks more like that of a victim suffering from St. Anthony’s Fire.27

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Fig. 7.8  Comparison of detail from Bosch, St. Bavo Giving Alms to the Poor and Sick, ca 1504–8 (fig. 7.7) with Leprosy Case Observed on Street (fig. 1.3).

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Interestingly, a similar scene of a fraudulent beggar with a choppedoff lower leg on a napkin also occurs in the St. Anthony Triptych. Such amputated limbs, according to Dixon, were readily available since the Antonite infirmaries stored them for their amputees in anticipation of the bodily resurrection on Judgment Day.28 How does the beggar fit into the complex program of Bosch’s triptych? Criminals and frauds surround the two saints, James and Bavo; should the leprous beggar be an exception? Is he duping his audience with a simulated disease? These questions cannot be answered without also taking into account the cultural background. From the fifteenth through the seventeenth century, false beggars became a popular topos in northern Europe. Prints frequently touched on that subject; Nürnberg’s imposter in Annual Leprosy Inspection (fig. 2.2, p. 27) has already been mentioned. Even the testimony of a sixteenth-century physician refers to that societal problem. Dr. Volcher Coiter, one of Nürnberg’s greatest specialists on leprosy, writes, “We find quite many who know how to make themselves up with glue and plasters and other trickery, to look as if they were really sick.”29 Thus I am inclined to pronounce Bosch’s beggar also a charlatan, all the more since St. Bavo is not a leprosy saint. The didactic message of the triptych presents the Christian saints as being perfect; they do God’s work on earth and one should emulate them rather than follow the rest of the corrupt world to damnation. One final general remark on leprosy subjects in Bosch’s oeuvre seems worthwhile. The creator of St. Bavo Giving Alms to the Poor and Sick was no doubt familiar with the idiosyncratic motives presented in a number of authenticated works by the master. For instance, the blemish on the beggar’s arm resembles the lower leg wound of the Antichrist in Bosch’s Adoration of the Magi, ca. 1510 (Prado, Madrid), which has been identified as a stylized manifestation of Hansen’s disease. At any rate, if one seeks the ultimate “sinner” represented as a leprous person—the way literature sometimes described him or her—a more likely candidate than this mischievous beggar would be Bosch’s perplexing allegory of the Antichrist.30 By the sixteenth century, the treatment of the leprous population must have become more humane; otherwise imposters would not have tried so hard to take their place. It is not known how many patients were actually living in leprosaria and how many sick were itinerant, supporting themselves as carnival attractions and worse; however, we seem to

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enter a very different sphere when we study the seventeenth century, when the number of leprosy commissions declined and leprosy subjects became scarce.

Secularization of Leprosy Subjects Northern artists can be credited with introducing secular topics that reflected social issues and with establishing altogether new iconographic traditions; these were by far their most innovative achievements. Even the title of the following masterpiece by Rembrandt (1606–69) has been questioned. This art historical discussion analyzes the painting by making use of some findings from the field of medicine. Rembrandt’s Man in Oriental Costume or King Uzziah Stricken with Leprosy in the collection of the Duke of Devonshire, at Chatsworth, has been categorized at times as a secular work, not intended for a religious environment. The majority of modern scholars identify the panel as a rare portrayal of King Uzziah Stricken with Leprosy (fig. 7.9).31 The painting is signed and dated; however, the signature has been challenged and the date interpreted to read 1633, 1635, or 1639. Both the Old Testament and Josephus’s Antiquities of the Jews record that King Uzziah desecrated the temple with his unauthorized offering at the altar of incense.32 The subject matter of Rembrandt’s masterpiece is fraught with problems. A Corpus of Rembrandt Paintings, presenting the state of research in 1986, provides the foundation for this analysis. Its summarized opinion reads: “A fairly well preserved and undoubtedly authentic painting from ca. 1639, the subject of which cannot be determined with certainty.”33 The main concern here is the man’s identity. The Corpus acknowledges Dr. Robert Eisler’s original contribution in 1948 when he identified the subject as King Uzziah (2 Chron. 26:16–22). Horst Gerson (1968) and Gary Schwartz (1984), among others, accepted Eisler’s hypothesis. Schwartz further specified that the master based the image on the Josephus text rather than on the Bible. In his Antiquities of the Jews 9.10, Josephus wrote that the first signs of the disease appeared on the king’s face rather than on his head. Since the man wears a turban covering his forehead, this deviation from the text is important (see p. 186). To Schwartz’s statements, I would add a few indispensable details. First, only Josephus mentions that the king entered the temple dressed like a priest, in a “holy garment.”34 Second, the passage Josephus expanded

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Fig. 7.9  Rembrandt (1606–69), Man in Oriental Costume or King Uzziah Stricken with Leprosy[?], ca. 1639, oil on panel. (In private collection of Duke of Devonshire, Chatsworth House, Derbyshire, UK. Used with permission.)

beyond scripture tells of an earthquake that damaged the temple and adds that the light streaming in caused the king’s leprosy. Although a secondary light source is discernable in the right background, according to the description of the painting in the Corpus, the light is entering

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from the left, through a window with a curtain, which does not necessarily identify the space as Jerusalem’s temple interior. Indeed, the Corpus categorically states that none of the objects depicted could be identified with the “golden altar.”35 The individual furnishings displayed in the dimly lit interior are difficult to decipher. Because I did not have the opportunity to study the painting under laboratory conditions, the Corpus’s description is given here verbatim: A round table stands against the rear wall, covered with a cloth and with a folding chair to the left of it. On the table an open book leans against a pedestal, with an unidentifiable object to the right of it. A gold-colored fluted column topped by a capital stands on the pedestal: a gold snake winds around it; while the capital has a mask with an animal’s head between two irregular convex shapes. The head is lion-like and has long horns, two fangs, and flaring nostrils. At the foot of the column, on the pedestal, there is a skull. Behind the column a wall candelabra with a long candle is set in a niche; to the left of this a satchel hangs from a long tasselled (?) strap.36

The serpent wrapped around a large column—visible in the background—has been repeatedly associated with sickness and healing. Yet it was the snake that convinced Christian Tümpel (1986) to identify Rembrandt’s painting as the portrait of Dan, one of Jacob’s twelve sons. The Corpus interjects that this theory is not completely convincing since “it does not account for the man’s blotchy skin, nor does it explain the column around which the snake is winding.”37 Furthermore, the report continues, the theme would have been difficult to read since the judge does not hold his rod of office as he does, for example, in the print Dan (fig. 7.10) by Jacques de Gheyn II (1565–1629) after Karl van Mander’s design.38 The portrayal of Patriarch Dan is based on the description in the Book of Genesis: “Dan shall achieve justice for his kindred, like any other tribes in Israel. Let Dan be a serpent by the roadside, a horned viper by the path. That bites the horse’s heel so that the rider tumbles backward” (Gen. 49:16–18) [emphasis added]. Numerous sixteenth- and seventeenth-century print series of the Twelve Patriarchs illustrate the viper as an attribute and as it attacks a rider. Tümpel correctly observed some similarities between de Gheyn’s composition and Rembrandt’s half-length, turbaned figure that dominates the picture plane. The symbol of the viper, though, does not seem to resemble the

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Fig. 7.10  Jacques de Gheyn II, Dan, ca. 1589. Engraving. (Harvard Art Museum, Fogg Art Museum, Gift of Norman Leitman in honor of Robert M. Light. M26068. Photo by Imaging Department © President and Fellows of Harvard College.)

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snake in the painting. Moreover, as already noted, the man represented in the Chatsworth panel is devoid of all identifiable attributes such as the knotted judges’ rod and the scroll. Unfortunately, scripture remains silent about a judge’s official raiment. Even though Dan is always placed in a landscape setting, Tümpel, in his interpretation of Rembrandt’s subject, ignored the depicted interior spaces; architectural backgrounds are visible on the left and on the right side behind the half-length portrait.39 Most important for the identification of the person are the facts that the sitter is not characterized with the emblems of his office and that most prints depict the militant Dan together with the figures of his foe in an outdoor setting. All of the above characteristics are missing. In my opinion, this image of an “anguished” man clasping his hands—portrayed with the background of an interior—is more befitting the character of King Uzziah pondering his divine punishment. The technical information, as presented in the Corpus, is also of prime importance for the description of the figure’s facial features. The nose, too, is painted in the light in such a way that the relief of the strokes produces a markedly uneven surface. One notices that in the flesh color streaks of a very light grey are used here and there small white splotches, some of which lie in the shadow of the eye pouch and around the eye. This gives the skin a diseased and somewhat moldy appearance. A few patches of a dark grey-brown are placed on the ridge of the nose.40

Rembrandt scholars generally agree that the skin looks “diseased,” although none of them (except possibly Dr. Eisler) seems to have investigated specific manifestations of Hansen’s disease, which the master may have recorded in this magnificent portrait. I consider as telltale signs not so much the large splotches and skin blemishes on the cheeks, but rather the granular appearance and the swelling of the lower and upper eyelids on the man’s right eye. Most significant for the characterization of leprosy symptoms is the passage about the deviant handling of colors on the “ridge of the nose” (it is visible without magnification). That leprosy can attack the nose, eyes, and eyelids has been frequently addressed throughout this study. Beyond these suggestive remarks, a more definitive diagnosis cannot be achieved. I base my identification of the painting as King Uzziah on more concrete observations: (1) the

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date the painting was executed, (2) the objects found in the enigmatic background, (3) the expressive pose, and (4) the man’s priestly attire. Not discussed in the Corpus, but of great value, are the observations by Jakob Rosenberg (1948), who followed C. Hofstede de Groot’s suggestion (1916) that the rich garments and the jeweled clasp are befitting a high priest. I had independently come to a similar conclusion after reading the prescribed costume for a Hebrew priest in Exodus 28:6–29. The importance of the turban is mentioned especially in the instructions for the ordination of Aaron’s sons and other Hebrew priests (Lev. 8:1–13; only Aaron, as high priest, was privileged to wear a miter). Rembrandt painted one of the two ceremonial ribbons (generally part of a miter, but not on a turban) draped over the man’s right shoulder, commonly seen in portrayals of a Hebrew priest officiating in the temple. The biblical text describes the intricately fashioned turban adorned with the “golden head-plate,” the white shirt, the tunic with decorative edges, as well as the ornate “breastplate.” Many of these items correspond with details in Rembrandt’s portrait. In 2009, Shelley Perlove and Larry Silver, in Rembrandt’s Faith, added another convincing identifying comparison by citing Rembrandt’s etching ἀ e Presentation in the Temple (1639–41), in which the high priest wears an outfit and turban similar to that of the man in our painting.41 Moreover, scripture recounts Uzziah’s fate after he had committed his sacrilege: “he fled willingly for the Lord had afflicted him. King Uzziah remained a leper to the day of his death. As a leper he dwelt in a segregated house for he was excluded from the house of the Lord” (2 Chron. 26:20–23). Josephus reports that “he [Uzziah] did as he was commanded, and underwent this miserable and terrible punishment … died in grief … and was buried by himself in his own gardens.” Both ancient literary sources are in agreement that victims of leprosy should not live or even be buried in the proximity of other members of society. To complete the analysis of the painting, the ambiguous space in the background needs to be addressed once more. According to the findings of the Corpus, similar interiors were repeated in Rembrandt’s circle as depicting a secular space.42 Thus the area cannot be identified with certainty as the temple in Jerusalem since the objects displayed are incongruous with a sanctuary—in particular the pouch hanging from the wall. I suggest that the background more closely resembles a private domicile, such as that to which the dethroned King Uzziah was forced to

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retire while his son reigned in Judea. To my knowledge, other scholars have not advanced this particular argument. Although the name of the patron for this painting is unknown, modern scholars know much about Rembrandt’s acquaintances in Amsterdam. In the 1630s the master was associated with the famous Bible scholar Manasseh ben Israel. It is safe to assume, therefore, that Rembrandt was familiar with the works of Josephus (he even owned a copy at one time; see inventory 1664).43 The master created a number of historic themes inspired by the Old Law, the most famous being Belshezzar’s Feast (1635), for which Ben Israel provided the Aramaic text. Schwartz emphasizes that both stories, Belshezzar and Uzziah, dealt with the downfall of a biblical king who had desecrated the Temple of Jerusalem.44 Because no early modern renderings of the Uzziah subject are known, we are unable to compare the portrait with an established iconographic tradition. Seventeenth-century artists frequently searched for interesting topics not previously envisioned. Baroque painters— Rembrandt is an excellent example—highly valued Josephus’s historic accounts because his protagonists were frequently faced with deep emotional responses as a result of God’s commands. To be able to render an understated expression of a deep emotion was, after all, the ultimate goal of Baroque art and Rembrandt’s forte.45 During the early Amsterdam period, Rembrandt also etched his 1631 Lazarus Klep, ἀ e Leprous Beggar, recognizable as such a person only because of his attributes and prescribed clothing. The beggar is wrapped from head to toe in rags, leaving only his face uncovered. Even seen in profile, his features do not reveal characteristic signs of the disease, except possibly his sparse beard. He shakes his rattle with the right hand and has a cane braced against his body as he patiently sits on a stone embankment.46 In the 1630s, illnesses might well have been on people’s minds since one of the major pandemics of bubonic plague ravaged Europe from 1629 to 1635. The presented evidence supports the premise that Rembrandt was not only interested in events of the Old Testament but also in the topic of leprosy when he created the haunting image of what many perceive to be a portrait of King Uzziah stricken with leprosy. In the Chatsworth painting, the master seems to convey an “extended moment.” The king, after being afflicted with disease, is seen here in his segregated abode, still dressed as a priest but incapable of taking any further action. One

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has to admire the powerful psychological portrait of a grief-stricken person resigned to his fate, yet full of inner tension. The unprecedented somber mood is reflected less in his frozen features than in the positioning of his hands, firmly locked to contain his emotions. To reduce the history painting to the genre of a mere oriental portrait robs the work of its cultural ambience. In the Protestant northern provinces of the Netherlands, Old Testament scenes held a special meaning during the fight for religious freedom against the Spanish oppressors. The Dutch, like the ancient Israelites, believed themselves to be chosen people; they frequently equated Amsterdam with the New Jerusalem, and the concept of the temple became very meaningful. The Dutch also advocated high ethical standards to show themselves worthy of the freedom for which they had fought so hard.47 It might be argued that Rembrandt, in selecting Old Testament topics, was a man of his time, and this masterpiece may convey important issues concerning religion as well as disease. In accordance with the seventeenth-century Dutch preference for history paintings based on themes from the Old Testament, Pieter de Grebber (1600–53) utilized the Naaman story by creating several versions of Elisha Refusing the Gifts of Naaman. In these images, leprosy was no longer the didactic focus, but rather Elisha’s ethical behavior, which was to be imitated. In seventeenth-century Holland, the city government, along with private donations, supported leprosaria governed by wealthy private citizens who frequently commissioned group portraits to prove their social consciousness and generosity toward the poor. Rembrandt’s pupil Ferdinand Bol (1616–80) painted, for example, Four Regents of the Leprooshuis. Admittedly, secular subjects (not intended for a religious function), too, were only marginally associated with the disease. Still, except in prints, the lifestyles of anonymous victims of leprosy were ignored and remained largely unrecorded. In a somewhat different vein, illustrations re-creating customs related to ceremonies in which leprosy patients played a role became fashionable in the Netherlands. According to the exhibition catalogue Ars Medica, the time-honored tradition allowing people stricken with leprosy to parade through Amsterdam on Twelfth Night was abandoned in 1604. The etching by Claes Jansz Visscher the Younger (1586–1652), Procession of the Lepers on Copper Monday (fig. 7.11), is dated 1608, only four years after the celebration was canceled.48 The work depicts the “sick ones” in their prescribed costumes, carrying Lazarus clappers.

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Fig. 7.11  Claes Jansz Visscher, Procession of Lepers on Copper Monday, 1608, etching. (Photograph courtesy of Philadelphia Museum of Art.)

Linda Stone-Ferrier, however, proposes that the print may actually illustrate members of the carpenter guild dressed as the patients who were no longer allowed to collect alms for themselves. The rather lighthearted mood of the scene would support Stone-Ferrier’s assumption; the figures carry the symbol of the carpenter guild, the “Janneman,” like a trophy.49 Numerous children enjoy their freedom as they run along with the adults, asking for alms. A few figures of the motley crew have bells hanging on their belts as they make their way across town. In the background one sees isolated figures standing in front of entrance doors, presumably begging. A rider on the far left urges his horse to run faster; clearly he does not want to encounter this band of leprous beggars. One man in the procession stands out in the crowd. He does not wear his hat, as all other members of the party do, even the children. He is obviously defying the authorities by carousing in public. The balding middle-aged man lifts a large liquor jug to his mouth. From his hand dangles a clapper, which indicates that he enjoys, but also abuses the privileges of the city. Is he one of the frequently described “immoral” leprous inmates,

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the reason the old tradition may have been abolished in 1604? At any rate, because the print is not based on a textual source, it is not easy to determine the artist’s intentions beyond describing a recent event in a rather humorous fashion. Still, it is difficult to distinguish whether the people are truly victims of leprosy or simply members of the carpenter guild who reenacted the traditional procession—or both. The very fact that Adrien van Nieulandt’s painting Procession of the Lepers on Copper Monday, 1604, still commemorated the day as late as 1633 indicates that the leprous population was not yet forgotten.50 Rembrandt’s etching of Lazarus Klep, also created in the 1630s, is one of the rare portraits of such a figure in Dutch art that portray genuine empathy for the victim (Rembrandt does not display the notorious alms bowl). It is difficult to say whether the citizens of Amsterdam, as the people of Nürnberg before them, feared the wrath of God because of their lack of charity in times of plague. Yet topics of false beggars who faked the disease were also popular. An epigram on Jan Van der Velde II’s engraving of a Beggar, also dated to 1633, expresses the man’s fraudulent intentions: that he, as a healthy man, would run with his clapper and steal people’s money.51 This attitude recalls the cynicism popularized by Hieronymus Bosch already a century earlier. Cynical prints about the “inconvenient” leprous patients may have sold better.52 E  E  E Original research produced some results when using information from modern medicine to detect leprosy manifestations in historic works of art. Yet there are limitations when trying to diagnose disease in art. The paintings discussed in this chapter, especially when compared with medieval imagery, show greater stylistic changes and a declining interest in documenting the clinical progress of disease. Although the realism and artistic freedom of the era help shed new light on the topic, these same factors also allow for a greater chance of error in making assumptions and interpretations. These ambiguities, however, seem in part calculated. Narratives from the period of the 1450s to the 1750s are very sophisticated and frequently target specific audiences, be it Netherlandish medical practitioners or the papal court in the Vatican. Rosselli’s fresco, for example, underlines a metaphorical interpretation by

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neglecting to specify the victim’s symptoms. And the Dutch preference for Old Testament scenes during the plague years of the 1630s indicates that these subjects were not chosen at random but may have symbolized the more imminent danger of bubonic plague. In Protestant countries threatened by an epidemic, leprosy images seem to replace the religious plague scenes so popular in Catholic regions (see fig. 3.1, p. 54). The questions of why and when Hansen’s disease finally abated in central Europe remain unanswered. Did some of the precautionary measures of isolating the sick (lazar houses, attire) contribute to the decline? We lack conclusive evidence to answer these queries; however, for the art historical study, it is important to note that most Dutch, French, German, and English leprosaria had closed by the eighteenth century. Images of leprosy in art had decreased since the 1500s and vanished almost completely from mainstream art just about the same time as the institutions closed. This coincidence indicates that the rising threat and later decline of this disabling illness correlate to the quantity—though certainly not to the quality—of leprosy representations in Western art. Furthermore, without the details of where, when, and in what magnitude outbreaks of leprosy occurred in Europe, it is not possible to draw conclusions regarding the extent to which health reasons motivated patrons to choose leprosy themes. Yet the evidence that the subject matter flourished during the centuries when Hansen’s disease was endemic in most parts of Europe seems to indicate that “illness as metaphor” occupied peoples’ minds, even when, fortunately, the disease itself did not occupy their bodies.

Conclusions

Images of Leprosy as a European Cultural Phenomenon Until recently, art historians studied illustrations depicting scenes of leprosy primarily for their narrative content, for the most part overlooking many important medical and metaphorical indications of the disease. Leprosy as a European cultural phenomenon brings to mind the phrase “illness as metaphor,” which Susan Sontag applied to TB, cancer, and AIDS.1 An examination of images of leprosy patients supports the assumption that biblical precedents influenced the way European society at large, and above all, the victims, experienced the horrors of Hansen’s disease from post-Roman times until the eighteenth century. Most of the imagery related to leprosy was created in a religious context that endowed it with a certain authority, yet that context may limit what these images can tell about the role leprosy patients played in the overall societal scheme. By examining some of the most important subjects of leprosy, it is clear that depictions of leprosy in the visual arts, compared to the prodigious and varied references in literature, focused on a few themes selected primarily from scriptural and hagiographic sources. Interpretation of medieval religious images related to leprosy, studied in medical, religious, historical, and artistic contexts, revealed some new aspects in familiar artworks. For many centuries, images contained primarily religious, but also political messages. Analysis of Christological cycles, which include innovative scenes of leprosy, indicates that such art is emblematic of a Christ-centered kingship. In contrast, various murals depicting St. Sylvester baptizing the leprous Emperor Constantine were created almost exclusively for clerical circles. Both types represented, albeit under divine protection, imperial or ecclesiastic aggrandizement. In either case, political theology in Western art indicates a close relationship between spiritual and temporal issues 162

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during the Middle Ages. The meek victims of leprosy frequently served as conduits for powerful political rhetoric. The few medieval images depicting leprous persons both before and after their miraculous cure emphasized that they were no longer leprous “beggars” or disenfranchised persons, and stressed their reinstatement into society through their courtly attire (see figs. 2.6, p. 34; 2.7, p. 36; 6.4, p. 118; 6.5, p. 121). Surprisingly, however, most of the inmates depicted are not characterized by their social status. Leprosy was also used as an indicator of the seriousness of current political problems, with the elite using leprosy topics to convey specific messages. As Ober observed, “Except under special circumstances, leprosy and lepers had little audience appeal.”2 Leprosy imagery in the early modern period must be read quite differently: the depiction of leprous patients functioned as exempla in parish churches, teaching the faithful lessons about Christ and his saints. The paintings’ subject matter, however, was also carefully selected to underline the political importance of certain saints in relation to national and theological questions. In these images, the sick play supportive roles; they are not the main protagonists. With few exceptions, religious scenes presented those infected with leprosy in a positive light; however, the pictures always emphasized the patients’ frightening disfigurement. For many, disfigurement was “a visible mark of sin,” while for others the disease implied purgatory on earth and the salvation of the victim’s soul.3 Whether the manifestations of leprosy were depicted conventionally or highly realistically and with clinical correctness, all signified the dreaded fate of the reviled, setting them apart from the healthy population as social outcasts. Their uniform clothing rendered the sick anonymous; removed from public life and separated from loved ones, they even lacked all class distinctions. Their former lives and their present mental and physical anguish are not evident; they remain peripheral. The stricken barely show any emotions; the public perceived them as suffering in silence for their sins or those of others. They appear remote and remain enigmas, socially marginalized as leprous persons, their lives on this earth no longer considered to be of any consequence. For the art historical study, the theological concerns are of great importance. As far as we know, neither the patients nor their families nor the victims’ communities seem to have officially commissioned leprosy imagery (except possibly illuminated manuscripts for use in a lazar house, banners for processions, or façade decorations on hospitals).

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Scenes depicting leprosy were by and large not intended to aid the stricken, who lived in isolation. Images of medical patron saints do not serve as intercessors in leprosy hospitals. And while depictions of St. Elizabeth and other saints ministering to the sick were plentiful, few if any of these scenes seem to have been displayed in the chapels of lazar house (if such images existed, they have not survived). There is also no reason to assume that even the most common religious subject, Christ healing a leper, graced the walls of leprosaria. It is not clear why there were apparently so few commissions for works depicting leprosy sufferers; the response to outbreaks of the plague was quite different. Perhaps the social stigma of leprosy played some role, but this subject has not been studied. Ruling families or townships commissioned plague subjects in large numbers; they donated religious art for the good of the whole community, to appease God and to avoid future pandemics. These commissions, and the patrons’ proud intentions, are well documented.4 Such a discrepancy indicates that the ideological chasm that divided the “living dead” in the lazar houses from the men and women on the outside was deeper than once perceived. It seems that, after the pronouncement of the words “Mundo mortuus sis, sed Deo vivas” (“Be thou dead to the world but alive unto God”), the leprosy victim’s status changed to an austere, nonworldly existence. In the medieval world, leprosy victims were seen simultaneously as sinners and as beloved by the Lord. Fr. Martinus Cawley described the inmates of leprosaria as Nazirites: persons who, according to Numbers 6:8, are “holy to the Lord.”5 It is difficult, for times past, to reconstruct the lives and thoughts of leprosy victims or even of their healthy counterparts, but images can help. One of the insights attained from my research is that religious images rarely emphasized leprous victims as the focal point. They are overshadowed by the divine and the saints; at times they are reduced almost to staffage figures to identify the topos lepra. Around 1500, however, ideological changes in society provided an incentive for patrons to commission a few secular works; these were mostly group portraits of the patrons of leprosaria, although they rarely included a victim. Prints in particular generally depicted leprous beggars not as people to be pitied, but more likely as people to be accused, or at least suspected, of being imposters. The study of these images reveals the leprosy victim’s ambiguous standing in society. Leprosy images generally show only

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Christ, the saints, and doctors touching the victims’ disfigured bodies, since transmission was (and still is) not well understood. Some physicians already suspected, quite correctly, airborne transmission through the respiratory tract or contagion by contact with infected skin. The first section of this book is devoted to medical aspects of the study of leprosy. Perhaps most importantly, recent DNA research has shed new light on the long-debated question: Is the biblical lepra the same sickness as clinical leprosy? A 2009 study dated leprosy DNA found in a tomb in Jerusalem to the first century ce, providing the possibility that HD could have been included in the term sara’at. In contrast, we have convincing visual evidence that by the ninth century ce, New Testament lepra was at times identified with clinical manifestations of leprosy. By comparing historical depictions of leprosy victims with photographs of modern leprosy victims and by studying HD beyond its dermatological manifestations, it becomes clear from Carolingian and Ottonian biblical illustrations (figs. 2.4, p. 32, to 2.9, p. 42) that by the ninth and tenth centuries, at least in educated circles, clinical leprosy was recognized as a specific sickness and became synonymous with the term lepra in the New Testament. Careful examination of the visual material also shows that lepromatous leprosy (rather than tuberculoid or borderline cases) seemed to prevail in Europe. Modern science and written accounts confirm that Europeans are generally more prone to develop this multibacillary form of Hansen’s disease. Today, medical research is only beginning to understand environmental influences on the transmission of Hansen’s disease and is investigating possible links with the expansion of agriculture and the planting of new crops. This tentative connection with agriculture appears to hold true in the known production of leprosy imagery, which seems to run roughly parallel with stages in Europe’s agricultural development. During the Carolingian renaissance, when French and German art first includes realistic depictions of clinical manifestations of leprosy, extensive agrarian reforms were being implemented north of the Alps. Similarly, the European leprosy epidemic of the eleventh century coincided with the great land clearance movement that expanded cultivation into eastern territories. At this point, it is not possible to determine whether analogous conditions existed in medieval England and the fertile Pannonian plains (modern Hungary) where images of leprosy became abundant in the late medieval and early modern periods. Additionally, it is difficult

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to ascertain if early urbanization of Italy minimized the number of people infected with leprosy; in Italy, with the exception of St. Sylvester, leprosy was not a prevalent religious theme. It may be significant, however, that the Lombard King Rothari, who ruled the region around the fertile Po valley, introduced leprosy legislation in his code of law as early as the seventh century ce.6 It is also interesting that Balathal (India), where remains were found that show what may prove to be the oldest evidence of Hansen’s disease, was a large agrarian settlement in the period to which the remains are dated. It is of course possible that what appear to be cause and effect could simply be coincidental developments, but examining some interesting parallel developments in history may lead to further scientific discoveries about this enigmatic disease. Likewise, the worldwide fight to prevent transmission of Hansen’s disease and to avoid the debilitating effects of leprosy through early detection have led us to a more comprehensive understanding of the social challenges that burdened Europe over a thousand-year period. Artworks of that period, especially didactic religious images of the fifteenth century, address the viewers in an effort to teach them compassion toward the victims. They also record scientific discoveries about leprosy, reflected in the frightening appearance of the stricken, whose reactions include resignation, resolve, and spiritual hope. Fear of contagion is expressed by a few figures ministering to the sick, such as the cleric hearing confession (fig. 2.2, p. 27) who protects himself from infection by covering his mouth and nose. Other works reveal the creator’s reproach or cynicism. All of these images demonstrate the universality of the human experience of disease that is the key to understanding this tragic illness. This volume is by no means a definitive statement on this fascinating topic; rather it invites and hopes to inspire future research. The quest to understand the phenomenon of leprosy adds another piece to the complex puzzle of European history and culture in premodern times.

Appendix A

Sources Related to Leprosy Images Old Testament Vulgata Clementina (Latin); and Catholic Public Domain Version (English)

Exodus 4:6–8 4:6

Dixitque Dominus rursum: Mitte manum tuam in sinum tuum. Quam cum misisset in sinum, protulit leprosam instar nivis. And the Lord said again, “Put your hand into your bosom.” And when he had put it into his bosom, he brought it out leprous, resembling snow.

4:7

Retrahe, ait, manum tuam in sinum tuum. Retraxit, et protulit iterum, et erat similis carni reliquæ. “Put your hand back,” he said, “into your bosom.” He put it back and brought it out again, and it was like the rest of his flesh.

4:8

Si non crediderint, inquit, tibi, neque audierint sermonem signi prioris, credent verbo signi sequentis. “If they will not believe you,” he said, “and will not listen to the sermon of the first sign, then they will believe the word of the subsequent sign.”

Leviticus 13:1–46 13:1

Locutusque est Dominus ad Moysen, et Aaron, dicens: And the Lord spoke to Moses and Aaron, saying:

13:2

Homo, in cuius cute et carne ortus fuerit diversus color sive pustula, aut quasi lucens quippiam, id est, plaga lepræ, adducetur ad Aaron sacerdotem, vel ad unum quemlibet filiorum eius. The man in whose skin or flesh there will have arisen a diverse color, or a pustule, or something that seems to shine, which is the mark of leprosy, shall be brought to Aaron the priest, or to anyone you wish among his sons. 167

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Images of Leprosy [The term “leprosy” in ancient times was probably used to refer to a variety of different diseases affecting the skin.]

13:3

Qui cum viderit lepram in cute, et pilos in album mutatos colorem, ipsamque speciem lepræ humiliorem cute et carne reliqua: plaga lepræ est, et ad arbitrium eius separabitur. And if he sees that leprosy is in his skin, and that the hair has turned a white color, and that the place where the leprosy appears is lower than the rest of the skin and the flesh, then it is the mark of leprosy, and at his judgment he shall be separated.

13:4

Sin autem lucens candor fuerit in cute, nec humilior carne reliqua, et pili coloris pristini, recludet eum sacerdos septem diebus: But if there will be a shining whiteness in the skin, but it is not lower than the rest of the flesh, and the hair is of unaffected color, the priest shall seclude him for seven days.

13:5

et considerabit die septimo: et si quidem lepra ultra non creverit, nec transierit in cute priores terminos, rursum recludet eum septem diebus aliis. And on the seventh day he shall examine him, and if the leprosy certainly has not increased further, and has not spread itself in the skin, he shall seclude him again, for another seven days.

13:6

Et die septimo contemplabitur: si obscurior fuerit lepra, et non creverit in cute, mundabit eum, quia scabies est: lavabitque homo vestimenta sua, et mundus erit. And on the seventh day, he shall evaluate him. If the leprosy has become obscured, and has not increased in the skin, he shall declare him clean, because it is a scab. And the man shall wash his clothes, and he shall be clean.

13:7

Quod si postquam a sacerdote visus est, et redditus munditiæ, iterum lepra creverit: adducetur ad eum, But if the leprosy increases again, after he was seen by the priest and restored to cleanness, he shall be brought to him,

13:8

et immunditiæ condemnabitur. and he shall be condemned of uncleanness.

13:9

Plaga lepræ si fuerit in homine, adducetur ad sacerdotem,

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If the mark of leprosy has been in a man, he shall be brought to the priest,

13:10 et videbit eum. Cumque color albus in cute fuerit, et capillorum mutaverit aspectum, ipsa quoque caro viva apparuerit: and he shall look upon him. And when there is a white color in the skin, and it has an altered appearance in its hair, and also the same flesh seems alive,

13:11 lepra vetustissima iudicabitur, atque inolita cuti. Contaminabit itaque eum sacerdos, et non recludet, quia perspicuæ immunditiæ est. it shall be judged a chronic leprosy, which has grown into the skin. And so the priest shall declare him contaminated, and he shall not seclude him, because he is clearly unclean.

13:12 Sin autem effloruerit discurrens lepra in cute, et operuerit omnem cutem a capite usque ad pedes, quidquid sub aspectum oculorum cadit, But if the leprosy will have flourished, coursing through the skin, and will have covered all the skin from the head even to the feet, whatever falls under the sight of the eyes,

13:13 considerabit eum sacerdos, et teneri lepra mundissima iudicabit: eo quod omnis in candorem versa sit, et idcirco homo mundus erit. the priest shall examine him, and he shall judge that the leprosy that he possesses is very clean, because it has all turned to whiteness, and for this reason the man shall be clean.

13:14 Quando vero caro vivens in eo apparuerit, Yet truly, when the living flesh shall appear in him,

13:15 tunc sacerdotis iudicio polluetur, et inter immundos reputabitur: caro enim viva, si lepra aspergitur, immunda est. then by the judgment of the priest he shall be polluted, and he shall be considered to be among the unclean. For the live flesh, if it is spotted with leprosy, is unclean.

13:16 Quod si rursum versa fuerit in alborem, et totum hominem operuerit, And if again it will have turned into whiteness, and will have covered the entire man,

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13:17 considerabit eum sacerdos, et mundum esse decernet. the priest shall examine him, and he shall discern him to be clean.

13:18 Caro autem et cutis in qua ulcus natum est, et sanatum, But when there has been an ulcer in the flesh and the skin, and it has healed,

13:19 et in loco ulceris cicatrix alba apparuerit, sive subrufa, adducetur homo ad sacerdotem. and in the place of the ulcer, there appears a white or reddish scar, the man shall be brought to the priest.

13:20 Qui cum viderit locum lepræ humiliorem carne reliqua, et pilos versos in candorem, contaminabit eum: plaga enim lepræ orta est in ulcere. And when he will have seen the place of the leprosy lower than the rest of the flesh, and that the hair has turned white, he shall declare him contaminated. For the plague of leprosy has arisen from the ulcer.

13:21 Quod si pilus coloris est pristini, et cicatrix subobscura, et vicina carne non est humilior, recludet eum septem diebus: But if the hair is of the usual color, and the scar is somewhat obscure and is not lower than the nearby flesh, he shall seclude him for seven days.

13:22 et si quidem creverit, adiudicabit eum lepræ; And if it will have certainly increased, he shall judge him to have leprosy.

13:23 sin autem steterit in loco suo, ulceris est cicatrix, et homo mundus erit. But if it stays in its place, it is the scar of an ulcer, and the man shall be clean.

13:24 Caro autem et cutis, quam ignis exusserit, et sanata albam sive rufam habuerit cicatricem, But if flesh and skin has been burned by fire, and, having been healed, now has a white or red scar,

13:25 considerabit eam sacerdos, et ecce versa est in alborem, et locus eius reliqua cute est humilior, contaminabit eum, quia plaga lepræ in cicatrice orta est.

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the priest shall examine it, and if he sees that it has turned white, and that its place is lower than the rest of the skin, he shall declare him contaminated, for the mark of leprosy has arisen in the scar.

13:26 Quod si pilorum color non fuerit immutatus, nec humilior plaga carne reliqua, et ipsa lepræ species fuerit subobscura, recludet eum septem diebus, But if the color of the hair has not been changed, nor is the mark lower than the rest of the flesh, and the leprosy itself appears to be somewhat obscure, he shall seclude him for seven days,

13:27 et die septimo contemplabitur: si creverit in cute lepra, contaminabit eum. and on the seventh day he shall evaluate him. If the leprosy will have increased further in the skin, he shall declare him contaminated.

13:28 Sin autem in loco suo candor steterit non satis clarus, plaga combustionis est, et idcirco mundabitur, quia cicatrix est combusturæ. But if the whiteness stays in its place and is not very clear, it is the mark of a burn, and for this reason he shall be declared clean, because it is only the scar from a burn.

13:29 Vir, sive mulier, in cuius capite vel barba germinaverit lepra, videbit eos sacerdos, If leprosy will have sprung up in the head or the beard of a man or woman, the priest shall look upon them,

13:30 Et si quidem humilior fuerit locus carne reliqua, et capillus flavus, solitoque subtilior, contaminabit eos, quia lepra capitis ac barbæ est. and if the place is certainly lower than the rest of the flesh, and the hair is golden, and thinner than usual, he shall declare them contaminated, because it is the leprosy of the head and the beard.

13:31 Sin autem viderit locum maculæ æqualem vicinæ carni, et capillum nigrum: recludet eum septem diebus, But if he sees that the place of the spot is equal with the nearby flesh, and that the hair is black, he shall seclude him for seven days,

13:32 et die septimo intuebitur. Si non creverit macula, et capillus sui coloris est, et locus plagæ carni reliquæ æqualis: and on the seventh day he shall examine it. If the spot has not

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Images of Leprosy increased, and the hair has kept its color, and the place of the mark is equal with the rest of the flesh,

13:33 radetur homo absque loco maculæ, et includetur septem diebus aliis. the man shall be shaven, except in the place of the spot, and he shall be secluded for another seven days.

13:34 Si die septimo visa fuerit stetisse plaga in loco suo, nec humilior carne reliqua, mundabit eum: lotisque vestibus suis, mundus erit. On the seventh day, if the mark seems to have stayed in its place, and it is not lower than the rest of the flesh, he shall declare him clean, and, his clothes having been washed, he shall be clean.

13:35 Sin autem post emundationem rursus creverit macula in cute, But if, after his cleansing, the spot will have increased again in the skin,

13:36 non quæret amplius utrum capillus in flavum colorem sit immutatus, quia aperte immundus est. he shall no longer inquire as to whether the hair has turned yellow, because he is plainly unclean.

13:37 Porro si steterit macula, et capilli nigri fuerint, noverit hominem sanatum esse, et confidenter eum pronunciet mundum. Furthermore, if the spot has not increased, and the hair is black, let him know that the man is healed: and let him confidently pronounce him clean. [The spot has “stood still” in the sense of not increasing size or spreading.]

13:38 Vir, sive mulier, in cuius cute candor apparuerit, If a whiteness will have appeared in the skin of a man or a woman,

13:39 intuebitur eos sacerdos. Si deprehenderit subobscurum alborem lucere in cute, sciat non esse lepram, sed maculam coloris candidi, et hominem mundum. the priest shall examine them. If he detects an obscured whiteness shining in the skin, may he know that it is not leprosy, but a whitecolored blemish, and that the man is clean.

13:40 Vir, de cuius capite capilli fluunt, calvus et mundus est: The man whose hair falls off of his head is bald and clean.

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13:41 et si a fronte ceciderint pili, recalvaster et mundus est. And if the hair falls off of his forehead, he is bald in front and clean.

13:42 Sin autem in calvitio sive in recalvatione albus vel rufus color fuerit exortus, But if in the bald head or bald forehead there has arisen a white or reddish color,

13:43 et hoc sacerdos viderit, condemnabit eum haud dubiæ lepræ, quæ orta est in calvitio. and the priest will have seen this, he shall condemn him without doubt of leprosy, which has arisen in the baldness.

13:44 Quicumque ergo maculatus fuerit lepra, et separatus est ad arbitrium sacerdotis, Therefore, whoever will have been spotted by leprosy, and who has been separated at the judgment of the priest,

13:45 habebit vestimenta dissuta, caput nudum, os veste contectum, contaminatum ac sordidum se clamabit. shall have his clothes unstitched, his head bare, his mouth covered with a cloth, and he himself shall cry out that he is contaminated and filthy.

13:46 Omni tempore quo leprosus est et immundus, solus habitabit extra castra. The entire time that he is a leper and unclean he shall live alone outside the camp.

Leviticus 14:1–32 14:1

Locutusque est Dominus ad Moysen, dicens: And the Lord spoke to Moses, saying:

14:2

Hic est ritus leprosi, quando mundandus est. Adducetur ad sacerdotem: This is the rite for a leper, when he is to be cleansed. He shall be brought to the priest,

14:3

qui egressus de castris, cum invenerit lepram esse mundatam, who, departing from the camp, when he has found the leprosy to be

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Images of Leprosy cleansed,

14:4

præcipiet ei, qui purificatur, ut offerat duos passeres vivos pro se, quibus vesci licitum est, et lignum cedrinum, vermiculumque et hyssopum. shall instruct him who is to be purified to offer for himself two living sparrows, which it is lawful to eat, and cedar wood, and vermillion, and hyssop.

14:5

Et unum ex passeribus immolari iubebit in vase fictili super aquas viventes: And he shall order that one of the sparrows be immolated in an earthen vessel over living waters.

14:6

alium autem vivum cum ligno cedrino, et cocco et hyssopo, tinget in sanguine passeris immolati, But the other living one, with the cedar wood, and the scarlet, and the hyssop, he shall dip in the blood of the immolated sparrow. [In the earlier verse (14:4), the word “vermiculum” was used to refer to the dyed cloth, but now “cocco” is used. Each of those two Latin words refers to a dyed cloth by the source of the dye, which in both cases produces a reddish color in the cloth.]

14:7

quo asperget illum, qui mundandus est, septies, ut iure purgetur: et dimittet passerem vivum, ut in agrum avolet. And he shall sprinkle him who is to be cleansed seven times, so that he may be purified justly. And he shall release the living sparrow, so that it may fly away into the field.

14:8

Cumque laverit homo vestimenta sua, radet omnes pilos corporis, et lavabitur aqua: purificatusque ingredietur castra, ita dumtaxat ut maneat extra tabernaculum suum septem diebus, And when the man will have washed his clothes, he shall shave all the hair from his body, and he shall be washed with water. And having been purified, he shall enter into the camp, only to this extent: that he may remain outside his own tent for seven days.

14:9

et die septimo radet capillos capitis, barbamque et supercilia, ac totius corporis pilos. Et lotis rursum vestibus et corpore, And on the seventh day he shall shave the hair of his head, and his beard, and his eyebrows, as well as the hair of his entire body. And

Appendix A: Sources Related to Leprosy Images

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having washed his clothes again, and his body,

14:10 die octavo assumet duos agnos immaculatos, et ovem anniculam absque macula, et tres decimas similæ in sacrificium, quæ conspersa sit oleo, et seorsum olei sextarium. on the eighth day, he shall take two immaculate lambs, and a oneyear-old female sheep without blemish, and three tenths of fine wheat flour, which has been sprinkled with oil, as a sacrifice, and separately, one twelfth hin of oil. [A sextarium (Roman measure) is used in the Latin text to represent a log, which is an ancient Hebrew unit of liquid measure equivalent to 1/12th of a hin or about 1/3 of a U.S. quart.]

14:11 Cumque sacerdos purificans hominem, statuerit eum, et hæc omnia coram Domino in ostio tabernaculi testimonii, And when the priest purifying the man has presented him and all these things in the sight of the Lord at the door of the tabernacle of the testimony,

14:12 tollet agnum, et offeret eum pro delicto, oleique sextarium: et oblatis ante Dominum omnibus, he shall take a lamb and offer it for transgression, with the twelfth hin of oil. And having offered all these before the Lord,

14:13 immolabit agnum, ubi solet immolari hostia pro peccato, et holocaustum, id est, in loco sancto. Sicut enim pro peccato, ita et pro delicto ad sacerdotem pertinet hostia: Sancta sanctorum est. he shall immolate the lamb, where the victim for sin is usually immolated with the holocaust, that is, in the holy place. For just as with the one for sin, so also the victim for transgression belongs to the priest. It is the Holy of holies.

14:14 Assumensque sacerdos de sanguine hostiæ, quæ immolata est pro delicto, ponet super extremum auriculæ dextræ eius qui mundatur, et super pollices manus dextræ et pedis: And taking some of the blood of the victim, which was immolated for transgression, the priest shall place it upon the tip of the right ear of him who is being cleansed, and upon the thumb of his right hand, and likewise the foot.

14:15 et de olei sextario mittet in manum suam sinistram,

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Images of Leprosy And he shall send some of the twelfth hin of oil into his own left hand,

14:16 tingetque digitum dextrum in eo, et asperget coram Domino septies. and he shall dip his right finger in it, and he shall sprinkle it in the sight of the Lord seven times.

14:17 Quod autem reliquum est olei in læva manu, fundet super extremum auriculæ dextræ eius qui mundatur, et super pollices manus ac pedis dextri, et super sanguinem qui effusus est pro delicto, But the oil which remains in his left hand, he shall pour over the tip of the right ear of him who is being cleansed, and upon the thumb of his right hand as well as the foot, and upon the blood which was shed for transgression,

14:18 et super caput eius. and upon his head.

14:19 Rogabitque pro eo coram Domino, et faciet sacrificium pro peccato: Tunc immolabit holocaustum, And he shall pray for him in the sight of the Lord, and he shall accomplish the sacrifice on behalf of sin. Then he shall immolate the holocaust,

14:20 et ponet illud in altari cum libamentis suis, et homo rite mundabitur. and place it upon the altar with its libations, and the man will be duly cleansed.

14:21 Quod si pauper est, et non potest manus eius invenire quæ dicta sunt pro delicto assumet agnum ad oblationem, ut roget pro eo sacerdos, decimamque partem similæ conspersæ oleo in sacrificium, et olei sextarium, But if he is poor, and his hand is not able to find what has been said, he shall take a lamb as an offering for transgression, so that the priest may pray for him, and a tenth part of fine wheat flour sprinkled with oil, as a sacrifice, and a twelfth hin of oil,

14:22 duosque turtures sive duos pullos columbæ, quorum unus sit pro peccato, et alter in holocaustum: and two turtledoves or two young pigeons, of which one may be for sin, and the other as a holocaust.

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14:23 offeretque ea die octavo purificationis suæ sacerdoti, ad ostium tabernaculi testimonii coram Domino. And he shall offer them on the eighth day of his purification to the priest at the door of the tabernacle of the testimony in the sight of the Lord.

14:24 Qui suscipiens agnum pro delicto et sextarium olei, levabit simul: And he, receiving the lamb for transgression, and the twelfth hin of oil, shall lift them up together.

14:25 immolatoque agno, de sanguine eius ponet super extremum auriculæ dextræ illius qui mundatur, et super pollices manus eius ac pedis dextri: And when the lamb has been immolated, he shall place some of its blood upon the tip of the right ear of him who is being cleansed, and upon the thumb of his right hand, as well as the foot.

14:26 olei vero partem mittet in manum suam sinistram, Yet truly, he shall send part of the oil into his own left hand,

14:27 in quo tingens digitum dextræ manus asperget septies coram Domino: and dipping the finger of his right hand in it, he shall sprinkle it seven times before the Lord.

14:28 tangetque extremum dextræ auriculæ illius qui mundatur, et pollices manus ac pedis dextri, in loco sanguinis qui effusus est pro delicto: And he shall touch the tip of the right ear of him who is being cleansed, and the thumb of his right hand, as well as the foot, in the place of the blood which was shed for transgression.

14:29 reliquam autem partem olei, quæ est in sinistra manu, mittet super caput purificati, ut placet pro eo Dominum: But the remaining part of the oil which is in his left hand, he shall send upon the head of the one being purified, to appease the Lord on his behalf.

14:30 et turturem sive pullum columbæ offeret, And he shall offer a turtledove or a young pigeon,

14:31 unum pro delicto, et alterum in holocaustum cum libamentis suis. one for transgression, and the other as a holocaust, with their libations.

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14:32 Hoc est sacrificium leprosi, qui habere non potest omnia in emundationem sui. This is the sacrifice of a leper, who is not able to obtain all of the things concerning his cleansing.

Numbers 5:1–4 5:1

Locutusque est Dominus ad Moysen, dicens: And the Lord spoke to Moses, saying:

5:2

Præcipe filiis Israël, ut eiiciant de castris omnem leprosum, et qui semine fluit, pollutusque est super mortuo: “Instruct the sons of Israel to cast out of the camp every leper, and those who have a flow of seed, and those who have been polluted because of the dead;

5:3

tam masculum quam feminam eiicite de castris, ne contaminent ea cum habitaverint vobiscum. cast out of the camp both male and female, lest they contaminate it while I am dwelling with you.”

5:4

Feceruntque ita filii Israël, et eiecerunt eos extra castra, sicut locutus erat Dominus Moysi. And the sons of Israel did so, and they cast them out, beyond the camp, just as the Lord had spoken to Moses.

Numbers 12:10–15

12:10 nubes quoque recessit quæ erat super tabernaculum: et ecce Maria apparuit candens lepra quasi nix. Cumque respexisset eam Aaron, et vidisset perfusam lepra, Likewise, the cloud which was over the tabernacle withdrew. And behold, Miriam appeared to be white with a leprosy, like snow. And when Aaron had looked upon her, and he had seen the spreading of the leprosy,

12:11 ait ad Moysen: Obsecro, domine mi, ne imponas nobis hoc peccatum quod stulte commisimus, he said to Moses: “I beg you, my lord, not to impose upon us this sin, which we have committed foolishly.

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12:12 ne fiat hæc quasi mortua, et ut abortivum quod proiicitur de vulva matris suæ: ecce iam medium carnis eius devoratum est a lepra. Do not let this one be like one who is dead, or like an abortion that has been cast from the womb of her mother. Behold, half of her flesh is already consumed by leprosy.”

12:13 Clamavitque Moyses ad Dominum, dicens: Deus, obsecro, sana eam. And Moses cried out to the Lord, saying, “O God, I beg you: heal her.”

12:14 Cui respondit Dominus: Si pater eius spuisset in faciem illius, nonne debuerat saltem septem diebus rubore suffundi? separetur septem diebus extra castra, et postea revocabitur. And the Lord answered him: “If her father had spit on her face, should she not have been filled with shame for at least seven days? Let her be separated, outside the camp, for seven days, and after that, she will be called back.”

12:15 Exclusa est itaque Maria extra castra septem diebus: et populus non est motus de loco illo, donec revocata est Maria. And so Miriam was excluded from the camp for seven days. And the people did not move from that place, until Miriam was called back.

2 Kings 5:1–27 5:1

Naaman princeps militiæ regis Syriæ, erat vir magnus apud dominum suum, et honoratus: per illum enim dedit Dominus salutem Syriæ: erat autem vir fortis et dives, sed leprosus. Naaman, the leader of the military of the king of Syria, was a great and honorable man with his lord. For through him the Lord gave salvation to Syria. And he was a strong and rich man, but a leper.

5:2

Porro de Syria egressi fuerant latrunculi, et captivam duxerant de terra Israël puellam parvulam, quæ erat in obsequio uxoris Naaman, Now robbers had gone out from Syria, and they had led away captive, from the land of Israel, a little girl. And she was in the service of the wife of Naaman.

5:3

quæ ait ad dominam suam: Utinam fuisset dominus meus ad prophetam, qui est in Samaria: profecto curasset eum a lepra, quam habet. And she said to her lady: “I wish that my lord had been with the

180 

Images of Leprosy prophet who is in Samaria. Certainly, he would have cured him of the leprosy that he has.”

5:4

Ingressus est itaque Naaman ad dominum suum, et nunciavit ei, dicens: Sic et sic locuta est puella de terra Israël. And so, Naaman entered to his lord, and he reported to him, saying: “The girl from the land of Israel spoke in such a manner.”

5:5

Dixitque ei rex Syriæ: Vade, et mittam litteras ad regem Israël. Qui cum profectus esset, et tulisset secum decem talenta argenti, et sex millia aureos, et decem mutatoria vestimentorum, And the king of Syria said to him, “Go, and I will send a letter to the king of Israel.” And when he had set out, he had taken with him ten talents of silver, and six thousand gold coins, and ten changes of fine clothing.

5:6

detulit litteras ad regem Israël, in hæc verba: Cum acceperis epistolam hanc, scito quod miserim ad te Naaman servum meum, ut cures eum a lepra sua. And he brought the letter to the king of Israel, in these words: “When you will receive this letter, know that I have sent to you my servant, Naaman, so that you may heal him of his leprosy.”

5:7

Cumque legisset rex Israël litteras, scidit vestimenta sua, et ait: Numquid Deus ego sum, ut occidere possim et vivificare, quia iste misit ad me, ut curem hominem a lepra sua? Animadvertite, et videte quod occasiones quærat adversum me. And when the king of Israel had read the letter, he tore his garments, and he said: “Am I God, so that I could take or give life, or so that this man would send to me to cure a man from his leprosy? Take notice and see that he is seeking occasions against me.”

5:8

Quod cum audisset Eliseus vir Dei, scidisse videlicet regem Israël vestimenta sua, misit ad eum, dicens: Quare scidisti vestimenta tua? veniat ad me, et sciat esse prophetam in Israël. And when Elisha, the man of God, had heard this, specifically, that the king of Israel had torn his garments, he sent to him, saying: “Why have you torn your garments? Let him come to me, and let him know that there is a prophet in Israel.”

Appendix A: Sources Related to Leprosy Images

5:9

 181

Venit ergo Naaman cum equis, et curribus, et stetit ad ostium domus Elisei: Therefore, Naaman arrived with his horses and chariots, and he stood at the door of the house of Elisha.

5:10

misitque ad eum Eliseus nuncium, dicens: Vade, et lavare septies in Iordane, et recipiet sanitatem caro tua, atque mundaberis. And Elisha sent a messenger to him, saying, “Go, and wash seven times in the Jordan, and your flesh will receive health, and you will be clean.”

5:11

Iratus Naaman recedebat, dicens: Putabam quod egrederetur ad me, et stans invocaret nomen Domini Dei sui, et tangeret manu sua locum lepræ, et curaret me. And becoming angry, Naaman went away, saying: “I thought that he would have come out to me, and, standing, would have invoked the name of the Lord, his God, and that he would have touched the place of the leprosy with his hand, and so have healed me.

5:12

Numquid non meliores sunt Abana, et Pharphar fluvii Damasci, omnibus aquis Israël, ut laver in eis, et munder? Cum ergo vertisset se, et abiret indignans, Are not the Abana and the Pharpar, the rivers of Damascus, better than all the waters of Israel, so that I might wash in them and be cleansed?” But then, after he had turned himself away and was leaving with indignation,

5:13

accesserunt ad eum servi sui, et locuti sunt ei: Pater, et si rem grandem dixisset tibi propheta, certe facere debueras: quanto magis quia nunc dixit tibi: Lavare, et mundaberis? his servants approached him, and they said to him: “If the prophet had told you, father, to do something great, certainly you ought to have done it. How much more so, now that he has said to you: ‘Wash, and you will be clean?’’”

5:14

Descendit, et lavit in Iordane septies iuxta sermonem viri Dei, et restituta est caro eius, sicut caro pueri parvuli, et mundatus est. So he descended and washed in the Jordan seven times, in accord with the word of the man of God. And his flesh was restored, like the flesh of a little child. And he was made clean.

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5:15

Images of Leprosy

Reversusque ad virum Dei cum universo comitatu suo, venit, et stetit coram eo, et ait: Vere scio quod non sit alius Deus in universa terra, nisi tantum in Israël. Obsecro itaque ut accipias benedictionem a servo tuo. And returning to the man of God, with his entire retinue, he arrived, and stood before him, and he said: “Truly, I know there is no other God, in all the earth, except in Israel. And so I beg you to accept a blessing from your servant.”

5:16

At ille respondit: Vivit Dominus, ante quem sto, quia non accipiam. Cumque vim faceret, penitus non acquievit. But he responded, “As the Lord lives, before whom I stand, I will not accept it.” And though he urged him strongly, he did not agree at all.

5:17

Dixitque Naaman: Ut vis: sed, obsecro, concede mihi servo tuo ut tollam onus duorum burdonum de terra: non enim faciet ultra servus tuus holocaustum, aut victimam diis alienis, nisi Domino. And Naaman said: “As you wish. But I beg you to grant to me, your servant, that I may take from here the burden of two mules from the ground. For your servant will no longer offer holocaust or victim to other gods, except to the Lord.

5:18

Hoc autem solum est, de quo depreceris Dominum pro servo tuo, quando ingredietur dominus meus templum Remmon, ut adoret: et illo innitente super manum meam, si adoravero in templo Remmon, adorante eo in eodem loco, ut ignoscat mihi Dominus servo tuo pro hac re. But there is still this matter, for which you will entreat the Lord on behalf of your servant: when my lord enters the temple of Rimmon, so that he may adore there, and he leans on my hand, if I will bow down in the temple of Rimmon, while he is adoring in the same place, that the Lord may ignore me, your servant, concerning this matter.”

5:19

Qui dixit ei: Vade in pace. Abiit ergo ab eo electo terræ tempore. And he said to him, “Go in peace.” Then he went away from him, in the elect time of the earth.

5:20

Dixitque Giezi puer viri Dei: Pepercit dominus meus Naaman Syro isti, ut non acciperet ab eo quæ attulit: vivit Dominus, quia curram post eum, et accipiam ab eo aliquid.

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And Gehazi, the servant of the man of God, said: “My lord has spared Naaman, this Syrian, by not receiving from him what he brought. As the Lord lives, I will run after him, and take something from him.”

5:21

Et secutus est Giezi post tergum Naaman: quem cum vidisset ille currentem ad se, desiliit de curru in occursum eius, et ait: Rectene sunt omnia? And so, Gehazi followed after the back of Naaman. And when he had seen him running toward him, he leaped down from his chariot to meet him, and he said, “Is all well?”

5:22

Et ille ait: Recte. Dominus meus misit me ad te dicens: Modo venerunt ad me duo adolescentes de monte Ephraim, ex filiis prophetarum: da eis talentum argenti, et vestes mutatorias duplices. And he said: “It is well. My lord has sent me to you, saying: ‘Just now two youths from the sons of the prophets have come to me from mount Ephraim. Give them a talent of silver, and two changes of clothing.’”

5:23

Dixitque Naaman: Melius est ut accipias duo talenta. Et coëgit eum, ligavitque duo talenta argenti in duobus saccis, et duplicia vestimenta, et imposuit duobus pueris suis, qui et portaverunt coram eo. And Naaman said, “It is better that you accept two talents.” And he urged him, and he bound the two talents of silver in two bags, with two changes of clothing. And he set them upon two of his servants, who carried them before him.

5:24

Cumque venisset iam vesperi, tulit de manu eorum, et reposuit in domo, dimisitque viros, et abierunt. And when now he had arrived in the evening, he took them from their hands, and he stored them in the house. And he dismissed the men, and they went away.

5:25

Ipse autem ingressus, stetit coram domino suo. Et dixit Eliseus: Unde venis Giezi? Qui respondit: Non ivit servus tuus quoquam. Then, having entered, he stood before his lord. And Elisha said, “Where are you coming from, Gehazi?” He responded, “Your servant did not go anywhere.”

5:26

At ille ait: Nonne cor meum in præsenti erat, quando reversus est homo de curru suo in occursum tui? Nunc igitur accepisti argentum,

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et accepisti vestes ut emas oliveta, et vineas, et oves, et boves, et servos, et ancillas. But he said: “Was my heart not present, when the man turned back from his chariot to meet you? And now you have received money, and you have received garments, so that you might buy olive groves, and vineyards, and sheep, and oxen, and men and women servants. [Gehazi accepted money in exchange for a spiritual gift (healing) and so he was guilty of simony.]

5:27

Sed et lepra Naaman adhærebit tibi, et semini tuo, usque in sempiternum. Et egressus est ab eo leprosus quasi nix. So then, the leprosy of Naaman shall adhere to you, and to your offspring forever.” And he departed from him a leper, as white as snow.

2 Chronicles 26:16–23

26:16 Sed cum roboratus esset, elevatum est cor eius in interitum suum, et neglexit Dominum Deum suum: ingressusque templum Domini, adolere voluit incensum super altare thymiamatis. But when he had become strong, his heart was lifted up, even to his own destruction. And he neglected the Lord his God. And entering into the temple of the Lord, he intended to burn incense upon the altar of incense.

26:17 Statimque ingressus post eum Azarias sacerdos, et cum eo Sacerdotes Domini octoginta, viri fortissimi, And entering immediately after him, Azariah the priest, and with him eighty priests of the Lord, very valiant men,

26:18 restiterunt regi, atque dixerunt: Non est tui officii Ozia, ut adoleas incensum Domino, sed Sacerdotum, hoc est, filiorum Aaron, qui consecrati sunt ad huiuscemodi ministerium: egredere de sanctuario, ne contempseris: quia non reputabitur tibi in gloriam hoc a Domino Deo. withstood the king, and they said: “It is not your office, Uzziah, to burn incense to the Lord; rather, it is the office of the priests, that is, of the sons of Aaron, who have been consecrated for this same ministry. Depart from the sanctuary, otherwise you will be in contempt. For this act will not be reputed to you for your glory by the Lord God.”

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26:19 Iratusque Ozias, tenens in manu thuribulum ut adoleret incensum, minabatur sacerdotibus. Statimque orta est lepra in fronte eius coram sacerdotibus, in domo Domini super altare thymiamatis. And Uzziah, having become angry, while holding in his hand the censer so that he might burn incense, threatened the priests. And immediately a leprosy arose on his forehead, in the sight of the priests, in the house of the Lord, at the altar of incense.

26:20 Cumque respexisset eum Azarias pontifex, et omnes reliqui sacerdotes, viderunt lepram in fronte eius, et festinato expulerunt eum. Sed et ipse perterritus, acceleravit egredi, eo quod sensisset illico plagam Domini. And when the high priest Azariah, and all the rest of the priests, had gazed upon him, they saw the leprosy on his forehead, and they hurried to expel him. Then too, he himself, becoming terrified, rushed to depart, because immediately he had become aware of the wound of the Lord.

26:21 Fuit igitur Ozias rex leprosus usque ad diem mortis suæ, et habitavit in domo separata plenus lepra, ob quam eiectusfuerat de domo Domini. Porro Ioatham filius eius rexit domum regis, et iudicabat populum terræ. And so, king Uzziah was a leper, even until the day of his death. And he lived in a separate house, being full of leprosy, because of which he had been ejected from the house of the Lord. Then Jotham, his son, directed the house of the king, and he was judging the people of the land.

26:22 Reliqua autem sermonum Oziæ priorum et novissimorum scripsit Isaias filius Amos, propheta. But the rest of the words of Uzziah, the first and the last, were written by the prophet Isaiah, the son of Amoz.

26:23 Dormivitque Ozias cum patribus suis, et sepelierunt eum in agro regalium sepulchrorum, eo quod esset leprosus: regnavitque Ioatham filius eius pro eo. And Uzziah slept with his fathers. And they buried him in the field of the royal sepulchers, because he was a leper. And Jotham, his son, reigned in his place.

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Flavius Josephus, ἀ e Antiquities of the Jews, vol. IX, chapter 10. Translated by William Whiston in Josephus: Complete Works (Grand Rapids, MI: Kregel Publication, 1960), 208. “He [Uzziah] put on the holy garment and went into the temple to offer incense to God on the holy altar which he was prohibited to do…. In the meantime a great earthquake shook the ground, and a rent was made in the temple, and the bright rays of the sun shone through it, and it fell upon the king’s face, insomuch that the leprosy seized upon him immediately;… Now as soon as the priests saw that the king’s face was infected with the leprosy…and commanded that he should go out of the city as a polluted person….that he did as he was commanded, and underwent this miserable and terrible punishment for an intention beyond what befitted a man to have, and for the impiety against God which was implied therin. So he abode out of the city for some time, and lived a private life, while his son Jotham took the government; after which he died in grief and anxiety at what had happened to him, when he had lived sixty-eight years, and reigned of them fifty-two; and was buried by himself in his own gardens.”

New Testament Vulgata Clementina (Latin); and Catholic Public Domain Version (English)

Matthew 8:1–4 8:1

Cum autem descendisset de monte, secutæ sunt eum turbæ multæ: And when he had descended from the mountain, great crowds followed him.

8:2

et ecce leprosus veniens, adorabat eum, dicens: Domine, si vis, potes me mundare. And behold, a leper, drawing near, adored him, saying, “Lord, if you are willing, you are able to cleanse me.”

8:3

Et extendens Iesus manum, tetigit eum, dicens: Volo. Mundare. Et confestim mundata est lepra eius. And Jesus, extending his hand, touched him, saying: “I am willing. Be cleansed.” And immediately his leprosy was cleansed.

8:4

Et ait illi Iesus: Vide, nemini dixeris: sed vade, ostende te sacerdoti, et offer munus, quod præcepit Moyses, in testimonium illis.

Appendix A: Sources Related to Leprosy Images

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And Jesus said to him: “See to it that you tell no one. But go, show yourself to the priest, and offer the gift that Moses instructed, as a testimony for them.”

Mark 1:40–43 1:40

Et venit ad eum leprosus deprecans eum: et genu flexo dixit ei: Si vis, potes me mundare. And a leper came to him, begging him. And kneeling down, he said to him, “If you are willing, you are able to cleanse me.”

1:41

Iesus autem misertus eius, extendit manum suam: et tangens eum, ait illi: Volo: mundare. Then Jesus, taking pity on him, reached out his hand. And touching him, he said to him: “I am willing. Be cleansed.”

1:42

Et cum dixisset, statim discessit ab eo lepra, et mundatus est. And after he had spoken, immediately the leprosy departed from him, and he was cleansed.

1:43

Et comminatus est ei, statimque eiecit illum: And he admonished him, and he promptly sent him away.

Luke 5:12–15 5:12

Et factum est, cum esset in una civitatum, et ecce vir plenus lepra, et videns Iesum, et procidens in faciem, rogavit eum, dicens: Domine, si vis, potes me mundare. And it happened that, while he was in a certain city, behold, there was a man full of leprosy who, upon seeing Jesus and falling to his face, petitioned him, saying: “Lord, if you are willing, you are able to cleanse me.”

5:13

Et extendens manum, tetigit eum dicens: Volo: mundare. Et confestim lepra discessit ab illo. And extending his hand, he touched him, saying: “I am willing. Be cleansed.” And at once, the leprosy departed from him.

5:14

Et ipse præcepit illi ut nemini diceret: sed, Vade, ostende te sacerdoti, et offer pro emundatione tua, sicut præcepit Moyses, in testimonium illis.

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Images of Leprosy And he instructed him that he should tell no one, “But go, show yourself to the priest, and make the offering for your cleansing, just as Moses has commanded, as a testimony for them.”

5:15

Perambulabat autem magis sermo de illo: et conveniebant turbæ multæ ut audirent, et curarentur ab infirmitatibus suis. Yet word of him traveled around all the more. And great crowds came together, so that they might listen and be cured by him from their infirmities.

Luke 17:12–19

17:12 Et cum ingrederetur quoddam castellum, occurrerunt ei decem viri leprosi, qui steterunt a longe: And as he was entering a certain town, ten leprous men met him, and they stood at a distance.

17:13 et levaverunt vocem, dicentes: Iesu Præceptor, miserere nostri. And they lifted up their voice, saying, “Jesus, Teacher, take pity on us.”

17:14 Quos ut vidit, dixit: Ite, ostendite vos sacerdotibus. Et factum est, dum irent, mundati sunt And when he saw them, he said, “Go, show yourselves to the priests.” And it happened that, as they were going, they were cleansed.

17:15 Unus autem ex illis, ut vidit quia mundatus est, regressus est, cum magna voce magnificans Deum And one of them, when he saw that he was cleansed, returned, magnifying God with a loud voice.

17:16 et cecidit in faciem ante pedes eius, gratias agens: et hic erat Samaritanus. And he fell face down before his feet, giving thanks. And this one was a Samaritan.

17:17 Respondens autem Iesus, dixit: Nonne decem mundati sunt? et novem ubi sunt? And in response, Jesus said: “Were not ten made clean? And so where are the nine?

Appendix A: Sources Related to Leprosy Images

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17:18 Non est inventus qui rediret, et daret gloriam Deo, nisi hic alienigena? Was no one found who would return and give glory to God, except this foreigner?”

17:19 Et ait illi: Surge, vade: quia fides tua te salvum fecit. And he said to him: “Rise up, go forth. For your faith has saved you.”

Excerpts from Jacobus de Voragine, ἀ e Golden Legend St. Benedict, 1:191 “We also read that there was a man whose son was so badly afflicted with elephantiasis that his hair was falling out, his scalp was swollen, and the pus exuding from it could not be concealed. The father sent the boy to the man of God, who speedily restored him to health, for which favor they offered boundless thanks to God. Therefore the boy preserved in good works until he fell happily asleep in the Lord.”

St. Elizabeth, 2:311. “Again there was a woman with a horrible leprosy whom she bathed and put to bed, cleansing and bandaging her sores, applying remedies, trimming her finger nails, and kneeling at her feet to loosen her shoes.”

St. Silvester (Pope Sylvester I), I:64 (The text postdates most of the illustrations) “Constantine continued to persecute the Christians, and Silvester left the city and settled in the mountains with his clerics. The emperor himself, in punishment for his tyrannical persecution, fell victim to the incurable disease of leprosy.”

Text from Martène of Ordo I Ritual texts for the ceremony of sequestration (as quoted in Alice the Leper, translated by Martinus Cawley, xxiv). Although this version was printed in 1763, it must have been based on earlier documents, since many of the requirements were depicted in images as early as the fourteenth century.

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Images of Leprosy Ordo I forbid you ever to enter a church, a monastery, a fair, a mill, a market or an assembly of people. I forbid you to leave your house unless dressed in your recognizable garb and also shod. I forbid you to wash your hands or to launder anything or to drink at any stream or fountain, unless using your own barrel and dipper. I forbid you to touch anything you buy or barter for, until it becomes your own. I forbid you to enter any tavern; and if you wish for wine, whether you buy it or it is given you, you have it funneled into your keg. I forbid you to share house with any woman but your wife. I command you, if accosted by anyone while traveling on a road, to set yourself downwind of him before you answer. I forbid you to enter any narrow passage, lest a passerby bump into you. I forbid you, wherever you go, to touch the rim or the rope of a well without donning your glove. I forbid you to touch any child or give him anything. I forbid you to eat or drink from any vessel but your own.

Appendix B

ἀ e Most Prominent Saints Associated with Leprosy St. Anthony Abbot (251–356?) • feast day January 17 St. Anthony is best known as patron for the victims of “St. Anthony’s fire” (ergotism), which is sometimes confused with other skin diseases.

St. Benedict of Nursia (480–547) • feast days July 11, March 21 St. Benedict is credited with curing a boy of “elephantiasis”—the name medieval doctors gave Hansen’s disease.

St. Bernardino of Siena (1380–1444) • feast day May 20 St. Bernardino was accused of heresy and cleared himself of the charges through the miraculous healing of a leprous beggar by giving the beggar his own sandals.

SS. Cosmos and Damian (died 303?) • feast day September 26 These Arabian twin brothers were already venerated as medical saints in the early Christian period, but legends of their miraculous achievements have no concrete link to leprosy.

St. Damian “Father Damian” (1840–89) • feast day May 10 or April 15 In 1864, Saint Damian was sent to Hawaii and tended the congregation of leprosy patients in Molokai. He paid for his devotion to serve with his own health when he was diagnosed with HD in 1884.

St. Elizabeth of Hungary/Thuringia (1207–31) • feast day November 19 St. Elizabeth, famous for founding hospitals, is credited in later legends with great involvement with leprosy victims. In contrast to other sources, the Golden Legend speaks only of a single female leprosy victim.

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St. Elzéar (1286 [1295?–1323]) • feast day September 27 Saint Elzéar’s famous tomb, erected in 1381, portrays him as ministering to patients of a lazar house. Although he did not heal them on the spot, legend says six leprous inmates were healed after the saint left.

St. Francis of Assisi (1182–1226) • feast day October 4 The turning point of St. Francis’s life was when he overcame his repulsion and accepted the pain of ministering to patients in a leper hospital. Although St. Francis may have contracted leprosy himself, he was not credited with curing a person infected by leprosy.

St. George (died 303) • feast day April 24 It is said that a church dedicated to the Virgin Mary and St. George had a spring that cured all diseases. Over the centuries, George was invoked against leprosy, plague, and syphilis. We find St. George on many seals of lazar houses and hospitals, and he appears as a global logo of the international organization dedicated to bringing relief to leprosy victims.

St. Giles (St. Aegidius) (died ca. 724) • feast day September 1 As a youth, St. Giles is said to have cured a sick beggar (not a leper) by giving him his cloak. The modern Catholic Church considers him the patron of the disabled.

St. Job (Giobbe) The Eastern Church depicted St. Job from the ninth century with a halo, and associated Job with leprosy from an early date.

St. Josaphat (paired with St. Barlaam) • feast day November 27 Said to be the son of a fourth-century Indian king, St. Josaphat was raised without knowledge of aging, death, and sickness, until he one day escaped his tutors and saw a leprous and blind beggar—a life-altering experience.

St. Lazarus • feast day June 21 The story of the biblical beggar Lazarus is told in Luke 16:10–26. Although scripture does not specify the disease, the sore-covered beggar in Christ’s parable was depicted since the tenth century as

Appendix B: ἀ e Most Prominent Saints Associated with Leprosy

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a victim of leprosy. St. Lazarus became a success as titular saint of lazar houses.

St. Louis (1214–70) • feast day August 25 Despite the rules of Lateran IV (1215), St. Louis invited lepers and the poor to his table. He is sometimes depicted with a leprous person as his companion.

St. Martin of Tours (ca. 315–97) • feast day November 11 According to later versions of St. Martin’s legend, he encountered a beggar while serving as a missionary in Gaul in 355 and shared his cloak, which healed the man of leprosy. A miracle of a man cured of leprosy is also recorded at the tomb of a local French saint, Silvanus, after St. Martin’s name had been invoked.

St. Nicholas of Myra/Bari (died ca. 350) • feast day December 6 St. Nicholas’ sepulcher became the site of countless miracle healings, although, most likely, none of a leprous person.

St. Peregrinus (ca. 600) • feast day June 13 St. Peregrinus is rarely illustrated except in association with the St. Denis legend where Christ healed him of leprosy. According to one version of the St. Peregrinus legend, Christ placed the former victim’s leprosy mask on an inside stone pillar of a church to verify the miraculous event.

St. Philip Benizzi (1233–85) • feast day August 23 St. Philip is credited with curing a leper, but it is rarely, if ever, recorded outside of the city of Florence, Italy.

St. Sylvester (314–35) • feast day December 31 Emperor Constantine I, who contracted “leprosy elephantiasis,” had a vision of SS Peter and Paul and sent for St. Sylvester, who converted the emperor and baptized him in the Lateran. In gratitude for his cure, Constantine made many concessions to the Church before he died.

St. Thomas Becket (1118–70) • feast day December 29 St. Thomas’s shrine became a favorite pilgrimage site, particularly for persons suffering from leprosy. Many of the cures were only partial, to leave behind some proof of the miracle.

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St. Vincent de Paul (1580–1660) • feast days September 27, July 19 The Catholic Church now considers St. Vincent de Paul a patron saint for leprosy. In 1625, he founded the mission of the Lazarist, which might link him with leprosy (most likely in missions outside of Europe).

Endnotes Introduction (pages 1–7)

1. Manchester, “Leprosy,” 46. 2. For a more extensive bibliography, see the International Leprosy Association’s Global Project on the History of Leprosy, “Bibliography from San Diego Museum of Man,” available online at http://www.leprosyhistory.org/english/bibsd_ab.htm. 3. Brody, Disease of the Soul, deals primarily with medieval literature; since I found no correlation between the two sister arts, fiction and the visual arts, I abstained from comparisons. For literary discussions of leprosy, see Göhrig, “Die Darstellung des Aussatzes.” 4. I am not questioning, in regard to medical terminology, P. D. Mitchell’s thesis in “The Myth of the Spread of Leprosy with the Crusades.” This book, however, concentrates on the cultural pluralism of that period and its effect on the West.

Chapter 1 (pages 8–23)

1. Although Hansen is credited with detecting the first microbe in 1873, it was Robert Koch who in 1884 first completed the scientific analysis of the tuberculosis mycobacterium which, unlike M. leprae, can be reproduced in vitro. 2. In the mid-twentieth century, Ridley and Jopling developed a five-category classification system for leprosy: TT (full tuberculoid), BT (borderline tuberculoid), BB (borderline), BL (borderline lepromatous), and LL (full lepromatous); Binford and Meyers, “Leprosy,” in Binford and Connor, Pathology of Tropical and Extraordinary Diseases, 205–25, esp. 206–7. 3. On the question of whether there are ethnic and regional differences in contracting HD, see Bullock, “Mycobacterium leprae (Leprosy),” chap. 230 in Mandell et al., Principles and Practice of Infectious Diseases, 3rd ed., 1906–17. 4. Binford and Meyers, “Leprosy,” in Binford and Connor, Pathology of Tropical and Extraordinary Diseases, 205–25. 5. Daniel H. Connor, M.D., email communication with the author, April 3, 2010. 6. On the transmission of leprosy, see Renault and Ernst, “Mycobacterium leprae (Leprosy, Hansen’s Disease), chap. 252 in Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Disease, 7th ed., 3165. On transmission through nasal secretion, see Clay J. Cockerell, “Leprosy,” in Connor et al., Pathology of Infectious Diseases, 1:605–14, esp. 606: “although the exact mechanism of transmission is unclear, untreated lepromatous patients discharge large numbers of M. leprae in their respiratory secretions and for this reason one assumes that transmission is by aerosolized particles which pass through nasal mucosa.” There are other hypotheses on transmission; in Louisiana, for example, infected armadillos are suspected of playing a role in the transmission chain, see note 31 below. 7. See Demaitre, “Description and Diagnosis of Leprosy,” 332n29. See also Levis and Ernst, “Mycobacterium leprae (Leprosy, Hansen’s disease),” chap. 240 in Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 6th ed., 2888. 8. M. leprae can persist in the environment; Renault and Ernst, “Mycobacterium leprae (Leprosy, Hansen’s disease),” chap. 252 in Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed., 3165. 9. See Roberts and Manchester, Archaeology of Disease, 193–206, esp. 199, fig. 7.27, showing a “drop foot.” HD can also cause large, craterlike ulcerations on the soles of the foot, ibid., fig.

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7.24. It has been suggested that such wounds might have started with the irritation of a pebble in the shoe or sandal; see “Leprosy Pictures from UIowa.edu” at www.lib.uiowa.edu/hardin/md/ui/ leprosy.html. 10. Daniel H. Connor, M.D. (personal communication with the author), reported that the Hawaiian patient died of laryngeal stenosis. 11. As early as the thirteenth century, the physician Bernard de Gordon expressed doubts that the markers of leprosy always appeared first on the face; Demaitre, Leprosy in Premodern Medicine, 340–41, n84. In a verbal communication, Patricia Gallinek, R.N., confirmed that she has seen a strikingly similar neural leprosy case. 12. One of the first experimental drugs for leprosy, Promin, was tested at the leprosarium at Carville, Louisiana; see Triumph at Carville. 13. The numbers of infected patients worldwide is difficult to establish since many victims have not been reported to the medical authorities. WHO numbers are not available at this time. Demaitre (“Description and Diagnosis of Leprosy,” 336) suggests a ratio of “Three lepers per 10,000 persons” in fourteenth-century Europe. 14. For changes after taking curative drugs, see Manchester, “Leprosy,” 33–35. He also indicates that “there has not been any modification of pathological response to M. leprae during the past two millennia” (35). Unfortunately I could not get the photograph from India—Leprosy Patient Escorted to the Treatment Center (photo Global Project, Chandag2)—that would have demonstrated some of the early signs of HD: problems with walking, which made a cane necessary. 15. Patricia Gallinek, R.N., personal communication. She also informed me about therapeutic efforts and their limitations in advanced stages of HD, noting that facial reconstructions are especially difficult. 16. Grimm, “Global Spread of Leprosy Tied to Human Migration”; and Monot et al., “On the Origin of Leprosy.” 17. News of the find in India was reported in the New York Times in May 2009; Nicholas Wade, “A Skeleton 4,000 Years Old Bears Evidence of Leprosy,” New York Times, May 26, 2009. 18. For an excellent discussion of endemic regions in Asia, Middle East, and Europe, see Roberts and Manchester, Archaeology of Disease, 200–205, esp. 202. The oldest leprous bones found in France are dated to ca. 500 ce. Bones found in Hungary are dated to before 1000 ce. Although parts of Hungary (Pannonia) had been included in the Roman Empire, the region was sparsely populated. At the beginning of the second millennium, however, the situation changed because the roads along the Danube supplied an alternate route to the Middle East. Agriculture played and still plays a major role in the Pannonian basin. 19. For literary sources on leprosy, see Roberts and Manchester, Archaeology of Disease, 200. 20. I know of only a single source citing Leviticus (13:29–31) in a historic text on diagnosing leprosy. Demaitre (Leprosy in Premodern Medicine, 85) quotes a physician writing in 1572 who quotes the Bible when describing a patient’s symptoms: “Indeed, the text says, ‘When a man or a woman has lepra arise in the head … deeper than the rest of the flesh … because it is lepra.’” 21. For brief summaries of the debate of Bible scholars, see Watts, Epidemics and History, 47–48; and Manchester, “Leprosy,” 35. 22. Stanford’s observations were reported in “Bad to the Bone” in the “Breakthroughs” section of Discovery magazine, October 1994 (pp. 11, 14). 23. For the DNA test of a corpse with both HD and TB, see Donoghue, Holten, and Spigelman, “PCR primers that can detect low levels of Mycobacterium leprae DNA” (see also notes 16 and 17 above). Also of particular interest are Spigelman and Donoghue, “Unusual pathological condition in the lower extremities of the skeleton from ancient Israel”; Donoghue et al., “Co-infection of Mycobacterium tuberculosis and Mycobacterium leprae”; and Matheson et al., “Molecular Exploration of the First-Century Tomb of the Shroud in Akeldama, Jerusalem.” 24. I am grateful to Mark Spigelman, M.D., for clarifing the situation in ancient Palestine: “Leprosy was present even before the first century bce, we have just not proved it microbiologically.” Email to author, August 18, 2010. 25. The Temple Institute’s reconstruction plans of the last Temple in Jerusalem (destroyed

Endnotes Notes for pp. 20–25

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by Titus in 70 ce) indicated one chamber reserved for “lepers” (outside the sanctuary but within the compound). Other courts were reserved for women and Nazarites. This would indicate that in the first century ce, a more inclusive attitude was already established that contradicted Levitical law, which expelled the “unclean” from the community. This attitude was later generally attributed to Jesus’ teachings. Unfortunately, the website does not cite sources for its plan. See Temple Institute, “An Illustrated Tour of the Holy Temple,” online at www.templeinstitute.org/illustrated_tour.htm. 26. Over the years, historians have referred to “European leprosy epidemics.” The medical definition of “epidemic” is the occurrence of more cases of a disease than would be expected in a community or region during a given time period. In this book, I use the term “epidemic” loosely (as do most authors); although statistics are not available, the term indicates rising concern over a specific health problem. On the average incidence rate (AIR) of leprosy in Norway from 1851 to 1920, see the map in Irgens, Leprosy in Norway, 4; see also fig.1.7 (p. 21) and n13 above and n27 below. 27. Irgens, Leprosy in Norway, 112. A study of the Bombay region and Norway indicated that M. leprae can survive outside a living organism; Kazda, Ecology of Microbacteria, 43. Historic discussions of leprosy repeatedly refer to the importance of shoes for the patients. 28. On the similarity of the mycobacteria causing HD and TB, see Kazda, Ecology of Microbacteria, 110. At the XXVI Congress of the International Academy of Pathology (2006), Daniel H. Connor, M.D., was a keynote speaker on the topic of a rising threat of tuberculosis—today the biggest killer of adult humans—which has escalated since the beginning of the Industrial Revolution. He traced the disease back about seven thousand years to Catal Huyuk in the Middle East (this date can be confirmed by osteo-palaeography) and mentioned that “soil contained many species of mycobacteria and that the ancient settlers—the first to turn the soil—undoubtedly began to inhale many dust particles from the soil. This dust could have contained species of mycobacteria that colonized human lungs and eventually caused tuberculosis.” 29. Rafi et al., “DNA extraction and amplification”; and Donoghue et al., “Co-infection of Mycobacterium tuberculosis and Mycobacterium leprae.” 30. The comparisons and interaction of leprosy and TB are addressed in Levis and Ernst, “Microbacterium leprae (Leprosy, Hensen’s Disease),” chap. 249 in Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 6th ed., 2886–96. 31. Leprosy was most likely introduced into Louisiana by leprosy-infected French Canadian immigrants. Cajuns may have infected the people of the southern region and possibly even indigenous armadillos (it has not been established whether there is also transmission back from armadillos to humans). Information about these speculative suggestions was supplied by James L. Krahenbuhl, director of the National Hansen’s Disease Program (Leprosy Lectures, Walter Reed Army Medical Center, June 26, 2008). The recent case of a fourteen-year-old girl in Baton Rouge was written up in the Washington Post (Sally Squires, “A Scary Diagnosis Hits Home,” May 27, 2008). The story is noteworthy because the source of her infection is not known. Since international travel from endemic regions might bring new patients, it is important that all physicians should be knowledgeable of early symptoms since immediate detection is vital to a successful healing process.

Chapter 2 (pages 24–44)

1. Aretaeus’s writings were mostly forgotten between the fifth and the sixteenth centuries; Demaitre, Leprosy in Premodern Medicine, 90, 138. 2. Mayor, Greek Fire, Poison Arrows, and Scorpion Bombs, 120. 3. Lucretius Carus Titus, De rerum natura, trans. Rouse, esp. 231, 253, 285. Lucretius developed naturalistic explanations of the universe and proposed several theories on “atoms,” which he thought could be either life-giving or lethal. In the Middle Ages, theories on polluted air based on ancient texts became common. The “miasmas,” for example, were thought to bring bubonic plagues. These hypotheses were finally replaced in the nineteenth century by modern germ theory advocated by Robert Koch (who discovered the TB bacillus in 1882); Koch also validated Hansen’s discovery in 1873. In 1894, Yersinia pestis, the bacteria responsible for bubonic plague, was discovered. 4. Varro anticipated microbiology and epidemiology; see Mayor, Greek Fire, Poison Arrows,

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and Scorpion Bombs, 114. See also Demaitre, Leprosy in Premodern Medicine, 90, 153. 5. On the Junius Bassus Sarcophagus (Vatican, Rome), see Terrien, Iconography of Job through the Centuries, 28–29. Junius Bassus’s circle would have considered Job a precursor of Christ and a prophet of the resurrection. Terrien includes a drawing after one of the lost Provençale sarcophagi (fig. 5) that depicted Job and his wife: “as in the Junius Bassus frieze, Job’s wife raises her folds of the robe to her nostrils with her left hand while on a wooden fork she holds out a small circular bun that has been baked with the sign of the cross.” Again, the only explanation for her gestures is avoidance of infection. Terrien also includes a late ninth-century illumination (fig. 17) that shows Job with a halo and his wife making a protective gesture. The gesture was repeated countless times; see note 8 below, and fig. 2.2 (p. 27). 6. Where and when these protective gestures were first introduced in scenes of death is not known, but it was most likely in Byzantine depictions of Christ raising Lazarus. The most famous examples, though also one of the latest ones, is Giotto’s Christ Raising Lazarus in the Arena Chapel in Padua (circa 1310); for a reproduction, see Snyder, Medieval Art, ill. 593. The Romans, like many other ancient cultures, practiced cremation; they considered decomposing corpses dangerous because they feared infections. It is impossible to determine the role that “bad smells” played when examining individual images. Even so, in Christian art, protection against the smell of death seems to have been primarily associated with the biblical story of the raising of Lazarus (Luke 16:19–26). Since Christ assured Mary and Martha that Lazarus was alive, they are not depicted as squeezing their nostrils; only the uninitiated of the participants cover their noses and mouths. 7. For more on the Nürnberg broadsheet (fig. 2.2) of 1493, see note 9 below. 8. Holding a cloth or a sponge soaked with vinegar as protection against the miasmas was common during plague epidemics; see Boeckl, Images of Plague and Pestilence, figs. 1.8, 1.9, 3.2. Medical texts warned physicians to avoid the leprous patients’ breath during examinations or treatments; Demaitre, “Description and Diagnosis of Leprosy,” 333. 9. Demaitre (personal correspondence, 2001) informed me that the Fascicul medicine te Antwerpen, 1512, was based on the 1491 Venetian version Fasciculus medicinae, a book he had translated and published in 1988 in a facsimile edition. In the 1491 version, the physician was accompanied by torchbearers. During the Black Death, fires were used to isolate the sick from the healthy; we now know that fleas avoid extreme heat. Hence the 1512 version emphasizing the gesture of covering the nose; by modern standards this method would be considered less effective in fighting bubonic plague than an open flame—unless it is pneumonic plague, an almost always lethal disease that is transferred via the respiratory track (for an illustration, see Boeckl, Images of Plague, fig.1.9). It is of interest that the plague scene predates the Nürnberg broadsheet of 1493, which means that in the fifteenth century some of the medical theories were applied for both illnesses. However, it was not until the High Renaissance that Raphael made the protective gesture against miasmas emblematic of bubonic plague. His drawing ἀ e Phrygian Plague was popularized in the 1520s by Marc Antonio Raimondi in the print Il Morbetto. The gesture of avoiding contagion was repeated by Nicholas Poussin in his Plague of Ashod, and after that the gesture was repeated ad infinitum; Boeckl, Images of Plague, ill. 3.1, 49–50. 10. Kottek, Medicine and Hygiene in Josephus, 42–46. 11. Ibid., 43 and 79. Kottek remarked that after the Temple in Jerusalem was destroyed in 70 ce, Jews built most synagogues near the sea or a river to facilitate submerging the whole body in water for ritualistic purposes. For the story of Naaman (II Kings 5:1–27) being cleansed of leprosy in the Jordan River, see pp. 137–40, 179–84). 12. Park, “Medicine and Society in Medieval Europe.” In contrast to the Judeo-Christian tradition, the classical writers Hippocrates and Galen considered epidemics to be natural disasters; Demaitre, Leprosy in Premodern Medicine, 75–95. 13. To my knowledge, medical literature, whether ancient or modern, never associated the elephantine deformations (see fig. 1.4, p. 14) with the term elephantiasis. 14. For Josephus’s terminology, see Demaitre, Leprosy in Premodern Medicine, 86–92, 99, 130, 152. 15. Stoll, Die “Lorscher Arzneibuch,” 87. The medical compendium Lorscher Arzneibuch

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might hint at crippling effects when discussing the loss of nails (“manuum vel pedum et ungues cadent”). I am grateful to Luke Demaitre for supplying me with the Latin text. On the scarcity of medical literature, see Beccaria, I codici medicina. 16. Park, “Medicine and Society in Medieval Europe,” 68. 17. Codex Aureus von St. Emmeram in Regensburg, cat. 1 in Mütherich, Prachteinbände 870–1685, 14. 18. I appreciate the assistance of Daniel H. Connor, M.D., in providing the computer enlargement and his professional diagnosis. 19. Mütherich and Dachs, Das Evangeliar Ottos III, 44–45, 55. 20. A ninth-century pen drawing (Düsseldorf) depicts Christ with a leprous man who carries a horn (reproduced in Schiller, Iconography of Christian Art, vol. 1, ill. 532). In contrast to leprosy, there were colored warning signs for most other infectious diseases. For example, people who had come in contact with a plague patient were required to wear white or yellow (local preferences) bandanas. Physicians who had been exposed to the plague carried white canes and houses of plague victims were generally marked with white crosses. By the sixteenth century, even leprosy images began showing yellow clappers, and white hat ribbons, and other colored warning signs. 21. Ober, “Can the Leper Change His Spots?” 55. Since Ober searched mainly for dermatological manifestations, he did not mention hair loss and carrying a horn (due to voice loss) as artistic signifiers of clinical leprosy. 22. Watts, Epidemics and History, 44–48. An epidemic is defined as more cases of a disease than would be expected in a region during a given period. Since we know so little about actual numbers of patients before the nineteenth century in Norway, we can only gauge the reactions of the population affected by Hansen’s disease. 23. Demaitre, Leprosy in Premodern Medicine, 86–87. Albrecht Dürer may have created in 1526 an experiment in physiognomy in his Four Apostles (Alte Pinakothek, Munich) and have given visual form to the concepts of temperaments and humors (but not related to disease, and even this theory is based on a posthumous hypothesis), see Alte Pinakothek München, 176. 24. Demaitre, Leprosy in Premodern Medicine, 178, and tables 6.3 (types of leprosy) and 7.2 (G. de Chauliac’s list) on p. 218, and table 7.1 (lists of signs, chronologically arranged) on p. 220. 25. WHO considers the Justinian Plague of the fifth and sixth centuries to be the first pandemic of bubonic plague. Chauliac’s Grande Chirurgie, published in 1363, discusses both leprosy and bubonic plague; see Ogden, Cyrurgie of Guy de Chauliac. His treatise became an essential tool for diagnosing leprosy for many years to come. Although Chauliac’s study was based in part on earlier investigations, it included an innovative checklist to guide doctors during an examination; see Demaitre, “Description and Diagnosis of Leprosy,” 335. There seems to have been a decline of leprosy in Europe after the fourteenth century, but because medical sciences continued to make advances, the topic of leprosy was kept in the forefront for both physicians and the general public. Doctors became very conscientious in their efforts to render an accurate, but above all a “learned,” diagnosis. 26. The eighteenth-century text, as cited in Cawley’s translation of Alice the Leper, xxiv, was obviously based on earlier directives; the specific requirements are visually documented starting in the fourteenth century. The effectiveness—or ineffectiveness—of these rules was never tested. 27. It is reasonable to assume that centuries ago people feared that exposed wounds would spread the disease, which would have been the reason they included shoes in the required attire for leprosy patients when leaving their compound. This was not to protect the sick from injuries. 28. The development of a similar clinical realism is noticeable in images of bubonic plague; see Boeckl, Images of Plague, figs. 1.2, 1.3, and 1.5. After 1500, in regions dominated by Catholicism, a decline in scientific explorations of clinical realism becomes noticeable in the visual arts, especially after the Council of Trent (1545–64); Manchester and Knüsel, “A Medieval Sculpture of Leprosy in the Cistercian Abbeye-de-Cadouin.” The Cadouin photographs are courtesy of Luke Demaitre, who has studied the work in situ. According to his investigation there is no obvious institutional leprosy connection. 29. Manchester and Knüsel, “A Medieval Sculpture of Leprosy in the Cistercian Abbeyede-Cadouin,” 205.

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30. Manchester and Knüsel (ibid., 205) describe the symptoms as “lepromatous and near lepromatous.” Realistic leg injuries were not depicted before the early modern period; for Lazarus iconography, see p. 80. 31. Demaitre, Leprosy in Premodern Medicine, 100, pl. 4, shows a clinical sketch dated to 1778 of a patient with lepromatous leprosy that was used as the frontispiece in a book on leprosy. The drawing emphasizes the roundness, height, and uneven surfaces of the individual lepromas, as well as the characteristic placements of the markers. 32. The Holbein drawing exists in at least two versions and seems to have fascinated physicians for some time. One version is included in Lepra in the Netherlanden (12de–18de eeuw), ill. 19, p. 36, where it is identified as the work of Holbein the Elder (no location given). The drawing in the Fogg Art Museum (Harvard inv. no. 1949.2) bears a date of 1523; it uses black, red, yellow, and white chalk on antique laid paper (with no watermarks). Although most likely reworked in black and gray ink, the inclusion of yellow chalk would be unprecedented early in the oeuvre of the artist. 33. Portrait of a Young Man is discussed in Mongan and Sachs, Drawings in the Fogg Museum of Art, 3:194–95, reproduced on p. 196. In Ganz, Les dessins de Hans Holbein le jeune, this work is referred to as Jeune Lépreux. On the back of the unusual drawing, according to Ganz, appears an inscription: F. K. 1856 Hans Holbein Portrait of “U. von Hutten in seinem Todesjahre.” If this is an accurate transcription of the text there are linguistic problems, and incidentally, Ulrich von Hutten died of syphilis. What bothers me most about this unique sketch is that, if the person is indeed infected with leprosy, it is strange that he is still wearing ordinary sixteenth-century upperclass attire. This would be very unusual for a leprosy patient in 1523.

Chapter 3 (pages 45–66)

1. Rawcliffe, Leprosy in Medieval England, 48. Inmates of lazar houses often prayed for living and for deceased members of the community; ibid., 52–53. 2. Peyroux, “Leper’s Kiss.” See cover illustration for an example; saintly legends involving the penitential kiss are numerous. See also Rawcliffe, Leprosy in Medieval England, 146. On selfabasement, see Rawcliffe, Leprosy in Medieval England, 148–49; and Kupfer, Art of Healing, 135–36. According to Brody (Disease of the Soul, 101), leprosy was also referred to as the “sacred malady.” For Chauliac’s advice on how to talk to the patients, see Brody, Disease of the Soul, 103. 3. Mollat, Poor in the Middle Ages, 146. There can be no doubt that bubonic plague was considered a much greater danger to the majority of the public. The severity of the danger was reflected in gold (spent for care of the sick), fire (to burn all their personal possessions to avoid future infections), and gallows (as punishment for breaking the curfew laws). 4. According to Demaitre, “Description and Diagnosis of Leprosy,” 344, once the new diagnostic procedures were in place, they may have changed the fate of many victims who had been misdiagnosed as suffering from leprosy. 5. On early European leprosaria, see Park, “Medicine and Society in Medieval Europe,” 71; on leprosaria in medieval England, see Rawcliffe, Leprosy in Medieval England, 123. For diseased bones in cemeteries, see Demaitre, “Description and Diagnosis of Leprosy,” 340. On the state of European leprosaria, see Mach, Von Aussätzigen und Heiligen, 71. 6. On concern of spreading infection, see Demaitre, Leprosy in Premodern Medicine, 137–38. 7. On leprous patients taking the sacraments, see Rawcliffe, Leprosy in Medieval England, 236; see also note 21 below. 8. Hamilton (Leper King and His Heirs, 164, 164n25) quotes Alexander III’s 1181 encyclical, Cum Orientalis terra. By around 1200, all leprous knights had to join the order during the Crusades; see Hamilton, Leper King and His Heirs, 29; and Marcombe, Leper Knights, 6. See also Dols, “Leper in Islamic Society” (the article lacks evidence from before the fourteenth century). On Baldwin’s illness, see Saladin’s biographer Imad ad-Din al Isfahani (1125–1201) who wrote, “[The Franks] were concerned to keep him [Baldwin IV] in office, but they took no notice whatsoever of his leprosy”; quoted in Hamilton, Leper King and His Heirs, 241. 9. For Lateran III’s ruling, see Rawcliffe, Leprosy in Medieval England, 257. Alexander III, a lawyer by profession, must have been interested in the issues of leprosy in general; he granted

Endnotes Notes for pp. 49–53

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leprosaria an exemption of taxes; ibid., 256–57. On Old Testament Nazirites, see Cawley, Alice the Leper, xxiii. In Numbers 6:8, a Nazirite (in Hebrew: ryzn, nazir) is described as “Holy unto the Lord,” that is, a man or woman who was bound by vows to serve the Lord. Nazirites went through an ascetic initiation period, at the end of which they had to bring the prescribed “sin offerings” and “holocaust” to the meeting tent. In many ways, Nazirites occupied an ambiguous position similar to that of leprosy victims in society. To my knowledge, it has not been established for how many centuries the Office of the Dead was part of the separatio leprosorium ceremony. 10. On Lateran IV, see Watts, Epidemics and History, 55. See also chapter 2, note 21 (p. 199) on the ninth-century pen drawing of Christ Healing a Leper, the oldest known depiction of a victim being identified by his horn. 11. Kupfer, Art of Healing, 136, discusses the changes of the disease’s acceptance in France. 12. For leprosy as a political construct, see Watts, Epidemics and History, 41, 64–65. On Jacques Fournier’s confession—after he became Benedict XII—in which he cleared his conscience by recalling his “unconfessed sins,” see ibid., 63. See also Moore, Formation of a Persecuting Society, esp. 55. Rawcliffe emphasized that the 1321 French excesses were regional occurrences. On the mass hysteria, see Demaitre, Leprosy in Premodern Medicine, 5. Kupfer (Art of Healing, 146) states that people feared the leprous more than heretics and Jews because the community did not want to deal with the possibility that anyone at all—since all human beings were thought to be sinners— might contract leprosy. 13. See Gérard de Silva, “Cagots of Béarn, the Pariahs of France.” 14. Marcombe, Leper Knights, 6. Hamilton (Leper King and His Heirs, 6) names two contemporary biographies of Baldwin IV: the one by William of Tyre and a chronicle attributed to Ernoul. 15. Mitchell, “An evaluation of the leprosy of King Baldwin IV,” in Hamilton, Leper King and His Heirs, 245–58. 16. An Italian leprosy commission led by Gino Fornaciari in 1998–99 performed the DNA tests and the team diagnosed a case of severe lepromatous leprosy; Fornaciari and Ciranni, “Leprosy of Henry VII (1211–1242).” On the phenomenon of suicide, see Brown, Art of Suicide. Thoughts of suicide by incurable patients are reported in various documents, most likely to emphasize the severity of their suffering and pain. 17. I am grateful for the kind assistance of Fr. Martinus Cawley and Shawn Madison Krahmer, who offered great insight into this fascinating period piece. See Cawley, Alice the Leper. Also of interest is Krahmer, “Redemptive Suffering.” The posthumous biography, according to Fr. Cawley (Alice the Leper, xvii–xxii), was most likely written by Arnulf II, abbot of Villers, to support monastic reform efforts. Most of the medical symptoms would indicate that Alice was suffering from the final stages of lepromatous leprosy; however, the strange seizures and burning pain that tortured Alice like “purgatory or hell” remind one more of descriptions of attacks of St. Anthony’s Fire (Ignis sacer); see Dixon, Bosch, 79. For an illustration, see Mach, Von Aussätzigen und Heiligen, 42, ill. 25. 18. Cawley, Alice the Leper, xiii. A completely unrelated case presents proof that many patients suffering from the lepromatous leprosy do not lose their voices; see Richard, Medieval Leper and His Northern Heirs, 109, pl. 35. In 1836, a medical team studied a sixty-eight-year-old Icelandic female leprosy patient. The woman must have been in her final stages of lepromatous leprosy because she had been voted by the expedition the “most repulsive case.” By mere coincidence it was also reported that she sang throughout the whole session, while her distorted features were recorded in a clinical sketch. 19. Another famous person said to have suffered from Hansen’s disease is Robert I, “the Bruce of Scotland” (1274–1329). According to Rawcliffe, Leprosy in Medieval England, 53n37, despite modern investigations, his health status remains inconclusive. When I was in Hungary, I was shown an illustration of a fourteenth-century manuscript depicting King Lajos (Louis I, 1340–80) who, it is said, may have been infected with leprosy (Kepes Kronika, c. 1370, O raszagos Szechenyi konvvtar, Budapest). The illustration itself was difficult to read. 20. The general preoccupation of medieval people with leprosy can also be supported by naming a few more important people associated with Hansen’s disease. Hildegard of Bingen (1098– 1179), for example, published on medical aspects of the feared disease—though her discourse on

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menstruation would not have been reflected in the visual arts; Demaitre, Leprosy in Premodern Medicine, 166, 171–72, 175. Legends about El Cid at times included leprous beggars. On leprosy in secular fiction, see Brody, Disease of the Soul; and Göhrig, Die Darstellung des Aussatzes. The earliest publication dates of these legends, novels, and other sources, are of interest for this discussion. 21. The Council of Lambeth (1281) suggested only that the laity should receive unconsecrated wine during mass (served therefore in a different cup). For exact dates and the ideological debates involving the removal of the consecrated wine from the public, as well as the final decision of the Council of Constance (1215–18, Jan Hus trial), see Rubin, Corpus Christi, 70–73, esp. 72. However, Rubin does not suggest that fear of contagious diseases played a role in this theological debate. The fact that leprous patients were not allowed to receive communion with the rest of the healthy congregation is documented since 726. Alice died in 1250, before the changes in eucharistic rites—particularly opposed in England—were universally implemented. There is a general consensus among modern scholars that Alice’s being denied to share the chalice with other members of her order was most likely caused by fear of contagion since her disease was already quite advanced; see also notes 7 above (p. 197) and 22 below (p. 199). The problem is also frequently mentioned in literature. Early examples are the treatment of the Cagots, see note 13 above (p. 198); modern leprosy hospitals (including Carville in the United States) report that the patients and the staff drank from separate cups (presumably also fearing contagion). 22. On Abbot Sugerius’s chalice, see Distelberger, Western Decorative Arts, 5–12, esp. 7 and n16. The silver gilt filigrée band is studded with pearls and precious stones (although the top rim seems smooth), which seems to indicate the chalice was not meant to be raised to the lips. 23. Cawley, Alice the Leper, 15. 24. The Aristotelean term “concomitance” is explained by Rubin, Corpus Christi, 71. The Council of Trent discussed the eucharistic rites again in Session XXI. The St. Aloysius Altar, formerly assumed to be the work of Marcantonio Franceschini, was attributed in 1981 by D. Stephen Pepper to Aureliano Milani (1675–1749) and dated to the first quarter of the eighteenth century; e-mail from Gudrun Swoboda, curator, Kunsthistorisches Museum, Vienna. The dates coincide with the last major European epidemic of bubonic plague in Marseilles, in 1720 to 1721. On the epidemic, see Boeckl, Images of Plague and Pestilence, 155–56, and for similar plague images, see ibid., chap. 6, esp. 123–25. The large canvas can be seen with special permission in the depot of the KHM. It is an interesting work, based partially, I would guess, on a reversed print of Poussin’s Plague of Ashdod. The gray overpaint of the large stones on the steps seems to hide Poussin’s iconic rats. The subject of the Catholic clergy risking their lives to assist persons infected with a lethal disease became a common artistic theme after the Black Death, at least from the fifteenth to eighteenth centuries (see chap. 3, pp. 61–62, and figs. 2.2, p. 27, and 3.1, p. 54). Tridentine art emphasized plague communion scenes; see Boeckl, Images of Plague, 108–13. 25. This early diagnostic effort was illustrated in a number of recent publications, for instance, Richard’s ἀ e Medieval Leper, 103, pl. 26. 26. The fourteenth-century L’Éstoire d’Éracles, a French translation of William of Tyre’s Historia, is in the British Library, London. 27. Gersdorff ’s book was first published in 1517 by Johannes Schott; see Demaitre, Leprosy in Premodern Medicine, 113, 192–94, 203–4. Today, uroscopy is only recommended for ENL cases; Bullock, “Mycobacterium leprae (Leprosy),” chap. 230 in Mandell et al., Principles and Practice of Infectious Diseases, 3rd ed., 1909. 28. See also Demaitre, Leprosy in Premodern Medicine, 206. A modern physician examining a patient for leprosy would also consider the distribution of lesions, hypesthesia or anesthesia, gynecomastia, testicular atrophy, atrophy of intrinsic muscles of hands or feet, loss or thinning of eyebrows, nasal discharge, and nodular or diffuse thickening of ears. 29. For the report on the cauterization of St. Francis, see Rawcliffe, Leprosy in Medieval England, 238. Cauterization had been practiced since antiquity and was later adopted by Arabian physicians. The tradition of cauterizing lepromas was illustrated in the circa 1300 treatise Imperial Surgery (popularized in 1465). The illustration shows the patient’s front and back as well as the physician with a cauterization instrument. See Rousselot, Medicine in Art, 294.

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30. Livia Kölnei, personal communication with the author, 2009. 31. Vida, “Die Heilige Elizabeth,” esp. 60–62. In 1246, a leprosarium may have been opened in the city of Košice, Slovakia (now across the northeastern border of modern Hungary); ibid., 49. It is important to note that all clinical observations of leprosy in historic images must be considered hypothetical because we assume the disease depicted is lepra since the text on which the artist based the scene identifies it as such. 32. Golden Legend, II, 304; and Vida, “Die Heilige Elizabeth,” 58–64. 33. On pilgrimages, see Rawcliffe, Leprosy in Medieval England, 242–43. Illustration 24 represents a stained glass panel that depicts a miraculous cure of a female pilgrim at the Shrine of St. William (York Minster, ca. 1423). On St. Peregrinus, see ibid., 112–14. 34. For more information on the painting, see Boskovits and Brown, Italian Paintings of the Fifteenth Century, 291–99. Park (“Medicine and Society in Medieval Europe,” 73) suggests that the list of the leprosy miracles in Europe was short because only a few leprosy patients were admitted to sanctuaries and shrines. It seems more reasonable to me that only a few saints, like Benedict and Martin of Tours, were posthumously compared to the miraculous powers of Christ because lepromatous leprosy was an incurable disease. The thoroughness of research in preparation for canonization varied in the Catholic Church a great deal; therefore, fewer miracles pertaining to leprosy were recorded in more critical hagiographies like the Golden Legend or in the early literature of St. Francis. 35. Demaitre, Leprosy in Premodern Medicine, 45–50. Most European lazar houses were reported to have been built “outside the city walls,” although they were frequently located on busy thoroughfares. Cologne too seemed to have had four leprosaria outside the city walls. In 1243, a “hoff to Malaten” is noted in the city records; on its site today is the cemetery of Melaten (de.wikipedia. org/wiki/Melaten-Friedhof). 36. In hindsight, if the mayor was aware of an approaching plague epidemic, it is not surprising that he canceled the observations of Holy Week for out-of-town strangers. For predictability of such epidemics, see Boeckl, Images of Plague and Pestilence, 9–15. 37. Demaitre, Leprosy in Premodern Medicine, 49–50. 38. The clergy risking their lives for the spiritual good of the sick became a pictorial topos, particularly in seventeenth-century plague images; see fig. 3.1. After the Council of Trent, the Catholic Church, to assure the much-needed assistance of priests and nursing staff during a bubonic plague outbreak, granted those who died in the line of duty a status equivalent to that of a martyr.

Chapter 4 (pages 67–91)

1. For a better understanding of iconology, see Panofsky, Studies in Iconology. 2. Before beginning to research leprosy iconography, I was concerned that Western art had not contributed enough original images to qualify leprosy as a truly independent iconographic category; however there are an abundance of examples. Although leprosy was the first specific sickness to be portrayed in Western art, it was the iconography of bubonic plague that independently developed new, sophisticated, and more prolific subjects. 3. Josephat is more commonly depicted in Byzantine art. Réau notes that the similarity with the Siddhartha/Buddha biography was not acknowledged until the nineteenth century. The text of the Miroir Historial mentions not a cripple but a blind man to accompany the leprous person (Bibliothèque de Arsenal, Paris, Bettmann Archive). 4. The Martène text of Ordo I (dated 1763) is in appendix A (p. 190). 5. Whiteness as sign of lepra is mentioned first in Exodus 4:6–7 when Moses’s hand turned white (“leprosam instar nivis”). Numbers 12:9–15 tells of “Miriam, a snow-white leper” (“lepra quasi nix”). In 2 Kings 5:27, Gehazi is described the same way: “leprosus quasi nix.” 6. The group of copiously illustrated Greek manuscripts created after the iconoclastic controversy was studied by Kurt Weitzmann and John Lowden. Weitzmann (Byzantine Octateuchs, 3) discusses the importance of the illustrations as possibly being based on now-lost Hebraic prototypes. The Synagogue of Dura Europos gives evidence that Hebrew scenes did exist; some of these traditions lived on for centuries in Christian iconography. For one example, the plague of Ashdod,

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or the fall of Dagon (1 Sam. 5:4–6), see Boeckl, “A New Reading of Nicholas Poussin’s ἀe Miracle of the Ark in the Temple of Dagon,” esp. 124. 7. There are no direct influences on Ottonian images known, since the extant Octateuchs postdate them. The number of images selected to illustrate the first eight books of the Old Testament varied a great deal. Genesis contained 320 images; Exodus, 80; Leviticus, only 14. Numbers had 42 illustrations; Deuteronomy, 19; Joshua, 67; Judges, 50; and Ruth, 2. 8. Gustave Doré’s Old Testament illustration, Leper Being Sent out of Camp, circa 1865, shows a romanticized version of the scene. 9. There are many late medieval versions of the Biblia pauperum. These books contained important imagery that helped acquaint artists with the iconography of biblical figures and themes. A. C. Labiola and J. W. Smeltz’s representation of a block book in the British Library will demonstrate the principle of these iconographic schemata of typological comparisons; Biblia pauperum Facsimile, shows the customary tripartite composition. The image on plate N (p. 27) deals with leprosy and plague. On the right, we see Aaron and Miriam before Moses (ante legem). Miriam is here characterized as the prefiguration of the penitent Mary Magdalene. The center of the print shows Mary Magdalene before Jesus (sub gracia). And on the left is the repentant King David (sub legem) doing penance for having caused a plague epidemic that killed many Israelites. Interestingly, all three scenes deal with disease and repentance. 10. The anonymous late medieval work on popular theology, Speculum humanae salvationis, generally illustrates four typological scenes. For a fifteenth-century example of this work, see Wilson and Wilson, A Medieval Mirror, 164–65. The series begins on the left, showing the Baptism of Christ paired with ἀ e Molten Sea (the brass vessel for cleansing at the entrance of Solomon’s Temple; 1 Kings 7:23–25). On the right is Naaman Being Cleansed of Leprosy in the Jordan paired with ἀ e Hebrews Crossing the Jordan with the Ark of the Covenant (the twelve stones in the dry river bed prefigure the twelve apostles; Joshua 3:13–15). 11. The earliest known Uzziah illustration appears in an inconspicuous initial (ninthcentury manuscript, Paris, Bibliothèque Nationale, gr. 923, fol. 213v). See Ober, “Can the Leper Change His Spots?” esp. 48, which shows a fourteenth-century initial showing the king swinging a censor in front of the altar of incense; see also the discussion in chapter 7 (pp. 151–57). For Uzziah iconography, see note 44 (p. 212). 12. An early seventeenth-century drawing after an image in the Dometilla Cemetery, Christ Healing a Leper, does not show any signs of disease, either. Jesus raises his right hand in a speaking gesture and, with his left, the Savior reaches toward the kneeling man’s shoulder. After the sack of Rome in 410, the catacombs were forgotten and only rediscovered by chance by Bosio in 1578. These facts may account for a break in the tradition of depicting this particular miracle in Christian art until the ninth century. 13. The words describing Job’s wounds are ulcus (Latin) and shekken (Hebrew); this information was kindly supplied by Stephen Vicchio. A seventh-century Syrian Bible (Ober, “Can the Leper Change His Spots?” fig. 11) shows Job’s body covered with dots. A fifth-century Roman catacomb painting (Terrian, Iconography of Job, fig. 3) shows Job seated with boils. A ninth-century book illumination (Terrian, Iconography of Job, fig. 17) depicts St. Job seated, with wounds all over his body and a halo. An association with leprosy seems to have occurred early in the Eastern Orthodox Church, where by the eleventh century, Job had become a patron saint of the leprous population and later, like Lazarus, of syphilitics as well. In the West, Job is far less often mentioned as a leprosy saint since the Roman Catholic Church did not recognize Old Testament figures as saints until after the Council of Trent (there are exceptions; for example, St. Giobbe in Venice). 14. Williamson, Medieval Treasury, 66–67. 15. Leviticus does not seem to have influenced the visualizations of leprosy. Even in the medical discussions, only one physician mentions Leviticus; Demaitre, Leprosy in Premodern Medicine, 84. Although the New Testament clearly describes the Savior as touching the man to be healed, iconographic conventions generally portrayed Jesus as touching the blind man. This differentiation between Christ’s gestures would help distinguish miracles at first glance. 16. Codex Aureus of Echternach (ca. 1020–30), MS 156142, fol. 55v, Munich, Bayerische

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Staatsbibliothek, illustrates a scene with the returning healed leper; Brody, Disease of the Soul, ill. 7. A detail of a painting dated to 1632, found on the façade on the Hospice du St. Esprit, Bruges, and reproduced in Lepra in de Nederlanden (12de–18de eeuw), ill. 45, shows Christ Healing Ten Lepers very realistically; the patients have bandaged lower legs and carry clappers, cups, and crutches. The mural is interesting for two reasons: first, there is the association with a hospital (not likely a leprosarium), and second, the art may have been designed to appease God in the time of an epidemic because the painting is dated 1632, which was a plague year (see also p. 160). In the eighteenth century, Domenico Tiepolo prepared a sketch for a biblical illustration of Christ healing ten lepers that was never executed, most likely because leprosy was no longer relevant in Italy. 17. For the Lazarus legend, see Marcombe, Leper Knights, 3–6. Another theological association of Lazarus of Bethany with leprosy derived from an analogy that God, just as with the leprous population, let Lazarus die a second time. Domenico Feti (1588/89–1623) depicted one of the rare scenes of Christ in the House of Simon the Leper (reproduced in Bulletin of the Rhode Island School of Design 25, p. 13). The painting presents Christ, Mary, Martha, and Lazarus with their host, who is not showing any signs of disease, seated around the table. Two more figures are visible in the background, identifiable as Judas and the High Priest plotting Christ’s death. 18. “Saints,” in Oxford Dictionary of Byzantium, 3:1828. 19. For the first canonization, see Seppelt and Schwaiger, Geschichte der Päpste, 133. Nationality and social ranking of the saint can be of interest in assessing the meaning of the whole image. 20. Only a fraction of religious works survived the English church reform of the sixteenth century. Some of those are reproduced in Rawcliffe’s Leprosy in Medieval England, 176. Illustration 18 shows a ca. 1215 stained glass window of the Trinity Chapel in Canterbury Cathedral that was intended as “powerful propaganda for the shrine of Thomas Becket,” famous for miracle cures. A similar scene appears in the predella panel by Gentile da Fabriano at St. Nicholas’s shrine in Bari. St. George appears triumphantly on the Internet logo of the Global Project on the History of Leprosy, but the Catholic Church denied George his saintly status after Vatican II (1962–65). 21. The legendary St. Roch, who is said to have contracted bubonic plague, was as popular with the faithful as was the “leprous” beggar Lazarus, whose illness is not specified in scripture. 22. Kupfer, Art of Healing, discusses the lazar house and its chapel in St. Aignan. Although the lazar house itself is no longer standing, its contemporary chapel, Saint-Lazar, was most likely built in the middle of the twelfth century. This elegant chapel with carved architectural details does not show any traces of figurative paintings or sculpture. It was to serve “those whose visible mark of sin—disease—initiated a life commitment to penance”; Kupfer, Art of Healing, 32. Accommodations to allow pauperes Christi to participate in mass varied a great deal, depending on the availability of funds. In a small village church in Hungary, a simple outdoor chancel or pulpit provided the local leprous population with an outdoor space. In Germany, victims of leprosy could sometimes hear mass by looking through a small slit in the wall, where they would not be seen as a threat to the community. 23. One of the earliest narrative paintings showing Lazarus as a leprous beggar dates from the middle of the eleventh century and appears in Henry III Gospel Book, El Escorial, Spain (reproduced in Boeckler, Das Goldene Evangelienbuch Heinrich III, color pl. 2). For an even more elaborate treatment of the legend, see the ca. 1515 Spinola Book of Hours (held by the J. Paul Getty Museum and available on their website). St. Lazarus is rarely, if ever, portrayed as an isolated figure; images include at least the dog licking his feet to identify the saint. I have only studied the iconographic tradition in the fine arts; religious banners, for example, might follow different conventions. Such an object belonged to the Magdalene Leprosorium in Bruges (Louvre 20224; reproduced in Pannier, De geneeskunde in Brugge). I owe this information to Luke Demaitres’s research. 24. Kupfer, Art of Healing, 3. 25. For the Sylvester legend, see pp. 109–19. The earliest examples (ca. 969–1011) of the baptism scene is reproduced in Deshman, “Otto III and the Warmund Sacramentary,” esp. 5, ill. 4. The Stavelot Altar (ca. 1160; Morgan Library, New York) emphasizes Constantine’s qualities as a Christian ruler and paired his life with that of his mother, St. Helen, who is credited with finding the True Cross. This legend is almost always included in the monumental Sylvester cycles and the

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tradition continued well into the sixteenth century (see, for example, the sixteenth-century Bardi Chapel in Sta. Croce, Florence). Although the Eastern Orthodox Church honored Constantine as a saint, the Latin West did not; however, St. Sylvester remained saint of the papacy. (In 1959, my father received the honorary title of Knight in the Order of Pope St. Sylvester for saving the most important Austrian church bells from being melted down in WWII.) 26. For a reproduction of St. Benedict’s image in San Crisogono, see Lepra in de Nederlanden (12de–18de eeuw), fig. 11. The chapter on St. Benedict in the thirteenth-century Golden Legend (1:186–93, esp. 191) stressed the seriousness of the boy’s illness by calling it elephantiasis, thus emphasizing St. Benedict’s power of healing. 27. Thanks to Curator Poszler Gyorgyi, we found the Cseriny Altar is now in the National Gallery of Art, Budapest (inventory 3279). On St. Martin, see Rawcliffe, Art of Healing, 144–45. Artworks depict several other leprosy episodes of St. Martin’s life; for instance, the fourteenth-century St. Martin Bishop of Tour Kissing a Leprous Person (reproduced in Lepra in de Nederlanden, ill. 12). 28. The illuminated manuscript Legendarium (Kepes, Hungary) is owned by the Vatican Library and a reproduction was unavailable. For a reproduction of the St. Francis image, see Vida, “Die Heilige Elisabeth,” 55. 29. Little Flowers … and Life of St. Francis … , 56–59, esp. 58. 30. I thank Susan Jenson for introducing me to this 2008 edition of St. Francis’s biographies, ἀ e Little Flowers by Brother Ugolino and ἀ e Life of St. Francis by Saint Bonaventure (Baronius Press), which gives insight into the different historic approaches to writing about saintly miracles. For example, Bonaventure’s version was composed at the request of the General Chapter of the Franciscans; it is more factual and is concerned mainly with monastic events. On St. Francis’s associations with leprosy, see p. 242; on the gift of healing, pp. 329–38. Brother Ugolino’s version, on the other hand, was written in the first half of the fourteenth century; it is less factual but contains charming anecdotes, including the miracle of healing a leprous person (pp. 56–59). See also Voragine, Golden Legend, 2:229–30. For an example see the anecdote of St. Bernardino of Siena (1380–1444) who was also credited with healing a leprous man by giving him his sandals; the saint is frequently depicted as standing barefoot. After slipping on the saint’s shoes, the sick man noticed that over time, the sensitivity in his feet and legs was restored and eventually he was healed. Thomas Aquinus in Summa ἀe ologicae perceived the process of healing, like all natural events, as taking time. See Muzur et al., “Saints Protectors from Leprosy,” esp. 269–70. 31. For the Elizabeth iconography, see Vida, “Die Heilige Elisabeth.” See also pp. 122–29. 32. The interpretation of the saint’s expression was suggested by one of the anonymous readers. According to the Biblioteca Sanctorum, Rome, 5:735, the saint’s vita is based largely on oral tradition. Artistically, the sculpture is characteristic of the Provençal school, which developed independently from Italian artists working in Avignon. It is characterized by a less courtly and a more innovative, realistic style; see Schmidt, “International Gothic in Mitteleuropa.” 33. For the source of the St. Elzéar legend, see Baron, “Le Mausolée de Saint Elzéar.” On delayed miracles, see note 30 above (p. 202); and Rawcliffe, Art of Healing, 169. 34. Natali, Andrea del Sarto, 38–43. 35. Some photographs of Father Damien of Molokai (1840–89) are posted on www.fatherdamien.com. One shows the aging and sick Fr. Damien, his face and hands covered with lepromas, similar to the image on the tapestry created for his canonization mass. I have not seen paintings depicting Fr. Damien ministering to his patients, although they may very well exist. Many of the statues of Fr. Damien depict the friar with a single cane. One of the Hawaiian officials described “the helpless phase,” apparently shared by all patients, as so terrifying “that even demons would have pity on the patients.”

Chapter 5 (pages 92–106)

1. Kantorowicz, King’s Two Bodies, esp. 6, 42, 58–59, is a brilliant explanation of the duality of Christ and of medieval rulers. 2. Bartlett, Making of Europe, 1–6. 3. See Snyder, Medieval Art, 191–92, 255.

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4. My research and that of other scholars has produced only a few names of saints who were said to have healed leprosy (see also note 34, p. 203). Many of the other miracles recorded, we would now call “faith healing.” On the twelfth century development of kings as healers, see Bloch, Royal Touch. 5. The design in the Aula Leonis is reproduced in Snyder, Medieval Art, 192, ill. 227. See also ibid., 194–95. 6. On Charles in his own time, see Nelson, Charles the Bald, esp. 10–18. Nelson labels the period in Charles’s reign from 869 to 877 “Glittering Prizes” (220–53). On the historic background of that period, see ibid., 231–53, esp. 248. On the emperor’s philosophy as a Christ-centered ruler, see ibid., 237. Nelson explains that the king was paraphrasing Proverbs 8:15, and associates this quote primarily with Charles’s actions as king. She does not extrapolate further on the emperor’s philosophy as a Christ-centered ruler in regard to his art commissions. 7. On the gold relief on the cover of the Codex Aureus, now at Bayerische Staatsbibliothek in Munich (figs. 2.3–2.5), see Mütherich, Prachteinbände, 14. Charles the Bald was a lay abbot in the venerable Church of St. Denis near Paris at the time the repoussoire relief was commissioned. Since the institution was famous for its library and artifacts, some scholars propose that Charles’s imperial workshop was also located at St. Denis. Other art historians suggest, based on stylistic grounds, that the school of Reims was the place of origin. Wolfgang F. Vollbach (“Sculpture and Applied Art,” 259) writes, “The book cover represents a more advanced phase of evolution and already points the way to the following period”—meaning that the relief was created after the St. Emmeram Gospel was written and illuminated for Charles the Bald around the year 870 (ibid., 256). 8. For the original function of the object, see Mütherich, Prachteinbände, 14. Charles, like his grandfather, exploited the arts to enhance the royal prestige; see Hubert, Porcher, and Volbach, Carolingian Renaissance, 239. Not a word is written by any of the above-cited authors on the meanings of the four reliefs. 9. Nelson, Charles the Bald, 235. For other artworks commissioned during Charles’s late period (including the Ruler Portrait with Queen Richildis), see ibid., 234–35, 234n62. 10. Ibid., 221–22. 11. In contrast to the appearance of the leprosy victim, the patient in Healing of the Blind wears elegant, classical clothes with high-laced sandals. For the blinding of Charles’s son Carloman, see ibid., 16, 230–31. 12. For earlier interpretations of the meaning of the name Carolus Calvus, see ibid., 13. 13. The First Bible of Charles the Bald is preserved in the Bibliothèque nationale de France; the San Paolo Bible shows the Ruler Portrait with Queen Richildis. See also note 9 above. On Aretaeus, see Demaitre, Leprosy in Premodern Medicine, 220. 14. On body odor and fetid breath, see ibid., 218. On the emperor’s temporary burial and later transferral to St. Denis, see Nelson, Charles the Bald, 253 (see also note 7 above). 15. His court physician was accused of having poisoned Charles the Bald; Park, “Medicine and Society in Medieval Europe,” 68. Zedechias may have replaced the Irish doctor who had served Charles for about thirty years; Nelson, Charles the Bald, 16n36, 253n129). 16. Boeckler, Iconographische Studie, 7–8. Although most Ottonian Bibles emphasized miracles, leprosy scenes appear only in a few select manuscripts. One example is the Codex Egberti (Trier), which included the leper miracle, and a number of murals created in “Kaisernähe,” which included that scene. For further information, see notes 17–21 below. 17. For the life of Otto III, see Snyder, Medieval Art, 239. 18. Seppelt and Schwaiger, Geschichte der Päpste, 86. 19. The wall decorations are in poor condition. For the best preserved mural depicting Christ Healing a Leper, see Snyder, ill. 288. Also see K. Künstle, Die Kunst des Klosters Reichenau im IX. u nd im X. J ahrhundert und der neuentdeckte karolingische Gemäldezyklus zu Üb erlingen (Freiburg im Breisgau: Herder, 1924). 20. For the Hildesheim Column, see Snyder, Medieval Art, ill. 289. 21. Ibid., ill. 294, Gospel Book of Otto III. 22. Ibid., 242–44. See figs. 2.9, 2.10, 2.11 in this volume. Ober (“Can a Leper Change His

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Spots?” 55) calls these two images “before and after.” 23. Leviticus 14 describes the elaborate cleansing processes and purification sacrifices prescribed by God for all of the Israelites in every case where a person is declared “clean.” The subject of the cleansed leper’s offering (Weitzmann, Byzantine Octateuchs, 72; and Lev. 14:4–6) somewhat resembles the Ottonian scene; however, it is difficult to claim a specific Byzantine influence since all extant Octateuchs postdate the year 1000. Boeckler assumed a generic Eastern influence; Iconographische Studie, 7–8. 24. A similar scene of Christ Healing a Leper (Sistine Chapel, Rome) is discussed in chapter 7 (pp. 132–36). In the fifteenth-century mural, the typological innuendoes are far more complex and sophisticated (see figs. 7.1, 7.2). 25. The mosaic is reproduced in Schiro, Dom von Monreale, 105. 26. Snyder, Medieval Art, 291. 27. According to Lowden (Early Christian and Byzantine Art, 333), “the mosaicists [at Monreale] went far beyond anything previously attempted in Sicily. Here they provided a very extensive cycle of scenes from the Life of Christ.” The westernized mosaics differ from earlier Norman creations in Sicily in their style but, more importantly, in their iconographic content. 28. One of the cloisters in Monreale originally had a French fifteenth-century Lazarus capital similar to the one shown in figure 2.8 (p. 40); it has since been destroyed. It would be interesting to explore whether leprosy was a major issue on the island at that time. 29. Since the Index of Christian Art (Princeton Index) is a thematic register, one can gauge the ratio by the numbers of each subject created in a specific region.

Chapter 6 (pages 107–130)

1. For the historic background on the Investiture Controversy, see Seppelt and Schwaiger, Geschichte der Päpste, 149–206. 2. Eusebius of Caesarea, Life of Constantine, intro. and trans. Cameron and Hall. 3. The struggle that ensued between the Arian and Nicene factions was only briefly settled by the First Council of Nicaea. After Constantine’s death, the Eastern Church and the emperors leaned toward the concept that Christ was not equal to God the Father. By the fifth century, when the Acts of Sylvester were written, this polemic issue was especially prevalent in Byzantium but also began to affect the Latin West. Arianism was adopted by many of the Germanic tribes and was not defeated until the beginning of the eighth century. 4. The dates and the extent of Constantine’s participation in Christian persecutions are being debated. Although the Milan Edict of 313 legalized Christianity, one of Constantine’s enemies revived persecution for a few years without Constantine’s consent; therefore, Sylvester’s youthful experiences have not been verified. People sometimes postponed baptism for various reasons (to make a pilgrimage to the Jordan River or until shortly before one’s death), but the early Latin Church frowned upon this practice. 5. One theory maintains that the Donation of Constantine was not a Roman forgery but a creation of the Frankish kings to give them greater prestige and to provide an association with the heritage of the Roman emperors. In the spurious document, Constantine supposedly granted papal sovereignty to the Latin capital and large parts of Western Italy: “Tam palatium nostrum, ut prelatum est, quamque romae urbis et omnes Italiae seu occidentatium regionum provincias loca et civitates.” By 1440, Lorenzo Vallo proved that the document must be a fake. The Catholic Church acknowledged the document officially after Cesare Baronius (1538–1607) denounced the Donation in his Annales Ecclesiastici. 6. Mollat, Poor in the Middle Ages, 15–16. See also Rawcliffe, who cites other leprous Roman emperors sick with leprosy; Leprosy in Medieval England, 244–45. Pliny the Elder mentioned therapeutic bloodbaths for Egyptian rulers. 7. On the reform popes, see Seppelt and Schwaiger, Geschichte der Päpste, 137–204. 8. On the Tivoli frescoes and Old St. Peter’s, see Demus, Romanische Wandmalerei, 124–26, 232–33. 9. The specific sources for the program of the San Silvestro chapel are not known. More

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information will become available when the restoration is finished. A somewhat later source, the ca. 1260 Legenda Aurea by J. Voragine, tells the legend in the chapters, “St. Sylvester” and “Finding of the True Cross.” The subject was repeated in the Lateran’s loggia (ca. 1300), in the church’s narthex, and in the transept (as late as 1600). 10. Revelation 6:14–15 is based on Isaiah 34:4. 11. A Roman law forbade killing children, even those of their enemies. 12. In reality, at the time, the Lateran’s palace was already in the possession of the Latin Church. See Träger, Der reitende Papst. The popularity of the Sylvester legend in conjunction with that of St. Helen finding the True Cross can be assessed by the fact that the House of Bardi, a wealthy Florentine banking family, commissioned a Sylvester/St. Helen cycle, painted by Maso di Banco in the church of Santa Croce (1336–39), possibly referring to the church’s name. 13. On Innocent IV, see Kelly, Oxford Dictionary of Popes, 192–93. 14. I am very grateful to Gerhard Schmidt, who introduced me to a number of lesser-known Sylvester cycles. I also am beholden to Elizabeth Hartjens, her sister Maria Wieken-Mayser, and Mr. Konrad Gross for their assistance in gaining insight into the bibliography of the Cologne Sylvester cycle. See Steffens, “Die altern Wandgemälde auf der Innenseite der Chorbrüstungen,” first published in 1902. In the article, Steffens includes historic copies of the frescoes. Although not available outside of Germany, a new publication for the cathedral’s anniversary, Der Kölner Dom und alles was damit zusammenhängt, which includes a reprint of Steffens’ article and new illustrations based on the recent restoration, might supply greater insight into the political symbolism. 15. For the historic background of the double election, see Seppelt and Schwaiger, Geschichte der Päpste, 220–25. 16. Steffens was an astute historian; he understood the political messages and the meaning of medieval symbols. He even remarked on the contemporary clothing of Prefect Tarquin; however, he did not associate the mural specifically with contemporary political events and the resulting double election. 17. For the Chartres window program, see Manhès-Déremble, Les vitraux narratifs, 213, 254. In the twelfth century, the Cathars developed the concept of “spiritual baptism” or consolamentum. It is important to note that the cathedral window of Chartres does not make reference to the Donatio. Also see Delaporte, Les vitraux de la cathédrale de Chartres, 3:273–81, pl. 3.84. 18. Avril, Manuscript Painting at the Court of France, 10, 21. See also note 38 below. 19. Rawcliffe, Leprosy in Medieval Europe, 114, tells a similar legend of an English fisherman who watched St. Peter consecrating Westminster Abbey. For the legend of the stone mask, see ibid., 112–14; and on St. Denis and Peregrinus, ibid., 200, ill. 21. 20. See Marcombe and Manchester, “Melton Mowbray ‘Leper Head,’” esp. 90, pl. 1–2. See also Marcombe, Leper Knights, esp. 139, pl. 24. Both enigmatic sculpted heads are fascinating early studies of leprosy patients. 21. The six panels on the left are Elizabeth’s Birth, Betrothal, Elizabeth’s Vision, ἀ e Miracle of the Cross (with Roses), Miracle of the Ceremonial Gown, Departure of Her Husband to Join the Crusaders. The panels on the right are Elizabeth’s Expulsion from the Wartburg, ἀ e Ungrateful Woman, Elizabeth Bathing the Leprous Man, Elizabeth Cut a Sick Man’s Hair, Elizabeth’s Death and Raising Her Remains. A number of these scenes will be discussed again in regard to the Smrecany Altar, which has a similar program (see pp. 124–27). 22. On the concept of penance, see Kupfer, Art of Healing, 4. 23. Figures in ibid., 48–51, show images that depict the emblematic motif of bubonic plague: the dead or dying mother with the living child in her arms (see figs. 3.1, 3.2, 3.3, 6.2, 6.4, 6.6). Another characteristic scene depicts a collapsed monk, as in St. Gregory’s Propitiatory Procession (fig. 4.5). Also, figure 4.2 shows a stricken man who had carried plague corpses to their graves. 24. For the program of the altar, its provenance, etc., see Alte Pinakothek München, 250–52. 25. For the sketch of Self-Portrait of Holbein the Elder, see Lieb, Hans Holbein der Ältere, 112–13. Also see Alte Pinakothek München. 26. Virchov, “A Painting of Lepers by Hans Holbein the Elder.” 27. The Peace of Passarowitz (1718) resulted in an important treaty between the Ottoman

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Empire on one side and the Habsburg monarchy and the Republic of Venice on the other. 28. Farovic-Ferencic and Buklijas, “Image of a Leper (?)” 29. For a brief discussion on the Habsburg Empire and its Hungarian and Bohemian saints, see Boeckl, “Baroque Plague Imagery and Tridentine Church Reforms,” 187–96. 30. The concept how the earthly personas related to their eternal body changes over the centuries. On Guy de Chauliac’s advice, Brody, Disease of the Soul, 103.

Chapter 7 (pages 131–161)

1. For medical advances in the fourteenth century, see Demaitre, “Description and Diagnosis of Leprosy,” 48. For the situation in Nürnberg, see Demaitre, Leprosy in Premodern Medicine, 50–51. 2. For the best color reproduction of the scene (after restoration), see Pfeiffer, Sistine Chapel, pl. 13. For the contract the four painters signed in 1482, see ibid., 40n92. 3. Ettlinger, Sistine Chapel before Michelangelo, 86. Lewine, Sistine Chapel Walls, lxi–lxiii, 111, discusses the bibliography up to 1965. 4. Lewine, Sistine Chapel Walls, 35–40. 5. Ettlinger, Sistine Chapel before Michelangelo, 89–90; and Lewine, Sistine Chapel Walls, 58–64. 6. Pfeiffer, Sistine Chapel, 40, wonders if the “fatherly figure” behind the leprosy victim indicates that Rosselli had originally intended to paint the father with his possessed son from Matthew 17:14–19. Pfeiffer’s remark made me take a second look at the newly restored frescoes; I noticed the importance of the witness behind the patient and the fading of the facial spots. Raphael’s father-and-son group in his Transfiguration (1518–20) may very well have been inspired by Rosselli’s fresco. The High Renaissance master was also the first artist to combine again, after the High Renaissance, two consecutive biblical quotes in one painting (Matt. 17:1–8 and 17:14–19). In Florence, before and after the High Renaissance, continuous narratives were common in religious imagery. Important differences in the poses of the two fathers need to be mentioned: while Raphael’s figure gently guides his son toward Christ, Rosselli’s father draws back, arms stiff and slightly spread to indicate amazement. For miracles in progress and the concept that the healing process takes time, see Muzur et al., “Saints Protectors from Leprosy.” On partial miracles at the tomb of St. Thomas à Becket, see Rawcliffe, Leprosy in Medieval England, 177. 7. For Christ/Moses parallels, see Ettlinger, Sistine Chapel before Michelangelo, 86. Lewine, Sistine Chapel Walls, 105, discusses the association between Lent, purification, and Naaman’s cure (prefiguration of Christ’s baptism). 8. Carolingian and Ottonian depictions of Christ healing the leper were intent on characterizing the biblical disease as clinical leprosy (although contemporary medical treatises did not describe elephantiasis as showing paralysis and hair loss, etc., see pp. 28–36). In contrast, Rosselli does not seem to have firsthand knowledge of the physical signs of Hansen’s disease so much as of its literary tradition. Surprisingly, a computer enlargement reveals a (new-grown?) soft beard on the young man’s chin. 9. On Hugh of St. Victor, see Rawcliffe, Leprosy in Medieval England, 112. 10. Gibson, Paintings of Cornelis Engebrechtsz, 127–36, esp. 128, 234. The dimensions of the center panel are only 59 by 38 cm. (side panels, 59 x 17 cm.). 11. Frequently the most important figures, such as Elisha or the Holy Family (e.g., in Callot’s Flight into Egypt), are almost hidden. Mannerism dominated central Europe during most of the sixteenth century. The Council of Trent (1545–63) took a whole session to rule against these excesses in religious art, which might confuse the faithful, and it took the Roman Catholic Church’s imposed censorship about one hundred years to combat these offenses and implement changes by instructing their artists (Academy of St. Luke in Rome) how to design religious works that could be easily understood. 12. Gibson, Paintings of Cornelis Engebrechtsz, 130, discusses the typological sources and meanings in the Speculum humanae salvationis. 13. On “the unbeliever,” see Mellinkoff, Outcasts, 1:44–55, esp. 55. Although I had no time

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to research it, I suspect that bells (Schellen on “Jolly joker-like attires”) in northern Europe were commonly associated with leprosy. See Mach, Von Aussätzigen und Heiligen, 71, who refers to colored “Schellen.” More to the point, since the fourteenth century, a great variety of outfits reflecting local variations and civic regulations were depicted in art to indicate victims of Hansen’s disease. It was universal that they all had to cover the whole body, including the head. Unfortunately, this volume cannot accommodate all images that depict such institutional garments (as seen, for instance, in Pieter Bruegel’s Carnival and Lent, Kunsthistorisches Museum, Vienna, etc.). 14. Ober (“Can the Leper Change His Spots?” 47) was surprised that, in early book illuminations, Gehazi was not depicted with skin blemishes when confronted by Elisha. There are two possible reasons for this: (1). the Bible describes his illness as turning him “snow white”; and (2). the scene is not depicted in one of the small vignettes in the background where most viewers would expect to see them for a specific reason. 15. Gibson, Paintings of Cornelis Engebrechtsz, 128. 16. Ober, “Can the Leper Change His Spots?” 46. 17. For the checklists, see Demaitre, Leprosy in Premodern Medicine, 218, 220, where he presents a list of signs describing leprosy. Swollen joints are discussed as an equivocal symptom. 18. Ibid., 218: round eyes (univocal sign number one!). Similar enlarged palms are depicted in modern photographs of Hansen’s disease victims. Historically, they are usually grouped under the equivocal symptoms; i.e., they can but do not have to indicate leprosy. 19. Gibson, Paintings of Cornelis Engebrechtsz, 130. 20. Ibid., 132–33, Gibson attributes the two “soldiers” to his workshop (his son). I find the medical observations to be first-rate. 21. Apart from the clinical analysis, my line of reasoning is similar to the arguments and observations advanced by Gibson and Mellinkoff. 22. Trnek, Picture Gallery of the Academy of Fine Arts in Vienna, 46–51, esp. 46 and 50. See also Dixon, Bosch, 293–94. 23. Diane Withee was very helpful in suggesting background information; in particular, Dirk Bax’s contribution. On Philip the Handsome, see Bax, Hieronymus Bosch and Lucas Cranach, 315; Dixon, Hieronymus Bosch, 290–97, esp. 293–94; and Silver, Hieronymus Bosch, 139–236, esp. 236. And see Trnek, Picture Gallery of the Academy of Fine Arts in Vienna, 46. 24. The 2009 exhibition was presented by the National Gallery of Art, Washington, DC, and Spain, 2009. The bilingual catalogue, El Arte del Podre: Armaduras y Retratos de la Espana Imperial, shows the Portrait of Philip the Handsome (cat. 10), The panel was on loan from the Royal Museum of Fine Arts of Belgium, Brussels (Inv. no. 2405). 25. Trnek, Picture Gallery of the Academy of Fine Arts in Vienna, 50. 26. Prof. Joseph Leo Koerner (Harvard University) in his 2008 A. W. Mellon Lectures in the Fine Arts showed some pertinent details in the St. Anthony Triptych and in other authenticated works (such as the balancing trick to be typical for Bosch’s repertoire of describing conjurers, etc.). 27. I discussed the medical symptoms with Daniel H. Connor, M.D. Although he found the sharp angle of the dangling hand an indication that the beggar was trying to pass for a man infected with Hansen’s disease, Dr. Connor found the amputated leg especially suspicious because the toes did not show any deformation. 28. Silver’s diagnosis is supported by the association with the saint in the St. Anthony triptych. See also Dixon’s discourse on St. Anthony’s Fire (Bosch, 179–82). Unfortunately for our inquiry, Lukas Cranach’s copy of Bosch’s Last Judgment Altar (Staatliches Museum, Alte Meister, Berlin) does not contribute to the meanings of the outer wings since they display different religious figures (Christ and Mary). 29. On the topic of deceitful beggars, see Silver, “God in Details: Bosch and Judgment(s),” 629: “A beggar, a class that was usually suspected of faking infirmities and general idleness.” See also Demaitre, Leprosy in Premodern Medicine, 51. 30. The large eye-shaped protrusion on the beggar’s arm resembles the one in Bosch’s Antichrist displayed on his lower leg (covered by a translucent cylinder in the shape of a reliquary tube). They do not resemble actual lepromas; however, it is important to note that the placements on the

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Notes Images for of pp. Leprosy 151–160

bodies are convincing. 31. For the best color reproduction of the Chatsworth painting, see Gerson, Rembrandt Painting, cat. 70, p. 45. 32. On Uzziah iconography, see note 45, p. 212. I am particularly grateful to Eva and Nick Allen for their scholarly and technical assistance at the outset of my Rembrandt research. 33. Corpus of Rembrandt Paintings, vol. 3, A128, pp. 289–96, esp. 289. 34. On Dr. Eisler (letter to the Ashmolian Museum in the archive), see Corpus of Rembrandt Paintings, 3:294. See also Schwartz, Rembrandt, 176; and Josephus, Works … Antiquities of the Jews, ed. Whiston, 299–300. Antiquities of the Jews had most likely been available in Dutch since the sixteenth century. 35. Corpus of Rembrandt Paintings, 3:289; and Schwartz, Rembrandt, 176. According to Gerson (Rembrandt Painting, 222), the skin of Uzziah’s face is marked with white flakes, difficult to see in reproduction. Although the biblical text does not mention “whiteness” in the case of Uzziah’s lepra, Rembrandt was most likely familiar with the Old Testament stories of leprosy turning Gehazi and Miriam “white.” 36. Corpus of Rembrandt Paintings, 3:294. 37. Ibid., 3:289. 38. Tümpel, Rembrandt, 398. See also Corpus of Rembrandt Paintings, 3:294. 39. On Jacques de Gheyn II, see New Hollstein: ἀ e Gheyn Family, 1:38. On Dan, see Veldman and de Jonge, “Sons of Jacob.” 40. For the technical information, see Corpus of Rembrandt Paintings, 3:289. 41. Hofstede de Groot, Catalogue Raisonné of the Most Eminent Dutch Painters of the Seventeenth Century, vol. 6, n341. See also, Rosenberg, Rembrandt, 1:42: “the rich attire and the jeweled clasp on the old man’s cloak points to the representation of a high priest.” For an illustration of Aaron’s sons’ dress code, see Tanakh, Newly Translated and Annotated, ed. Sherman, app. C, ills. 7 and 11, and p. 219n8. See also Perlove, Rembrandt’s Faith, 129–30. I am very grateful to Shirley Bennett who supplied me with the new information before it was available in libraries. 42. Corpus of Rembrandt Paintings, 3:41–42. 43. Golahny, Rembrandt’s Reading, 78–79. 44. For Josephus, see Schwartz, Rembrandt, 176. 45. The oldest extant depiction of King Uzziah appears in a ninth-century figurated initial (Paris, Bibliothèque Nationale, gr. 923, fol. 213v), a small figurated initial of King Uzziah. A fourteenth-century manuscript portrays Uzziah swinging a censor (see also note 11, p. 204). Other than possibly a few more book illuminations, the subject has not been treated in Western art. On Rembrandt’s use of other Josephus stories, see Golahny, Rembrandt’s Reading, 165. 46. For the etching, see Boon, Rembrandt: Complete Etchings, cat. 52. 47. On one of the many discussions on the New Jerusalem and the meaning of the temple in modern literature, see Perlove, Rembrandt’s Faith. The National Gallery Research Library describes the book as follows: “The summary demonstrates the new ideas Rembrandt brought to the interpretation of Jerusalem’s Temple and the apostolate church, exploring the relationship between Jewish and Christian revelations in biblical history.” On Uzziah, see ibid., 129–30. 48. Karp, Ars medica. For secular prints, see Karp’s entry on 189–99. In 1595, a decree to eliminate fraudulent beggars was passed. It required beggars to have medical certificates declaring them to be infected with leprosy, which in turn guaranteed them official clappers. 49. For the role of the carpenter guild as well as customs and civic regulations, see StoneFerrier, Dutch Prints in Daily Life, 120–21. 50. Karp, Ars medica, 189n2. The painting by Adrien van Nieulandt is in the Amsterdam Historisches Museum. 51. Jan van de Velde II, illustrated in Hollstein, Dutch and Flemish Etchings, Engravings, and Woodcuts, 33:45. The Dutch text (translated by Luke Demaitre) reads: “I run with my clapper to collect money every day—money box in hand, but it is not for saving—I quickly spend it again—I steal folk’s money, soul, honor, and time.” 52. Karp, Ars medica, 188, cat. 51, displays a print by Hieronymus Cock (after Hieronymus

Endnotes Notes for pp. 162–166

 213

Bosch). The accompanying text explains that two similar Bosch drawings are extant, both depicting severely crippled beggars (Albertina, Vienna, and Cabinet des Estampes de la Bibliothèque Royale, Brussels). The drawing chosen for proliferation in print displayed far less sensitivity and empathy for the poor; obviously one expected higher sales from that design. Hansen’s disease cannot be diagnosed with certainty in the beggars depicted in the Bosch drawings.

Conclusions (pages 162–166)

1. I am grateful to one of my anonymous readers, who encouraged me to apply Susan Sontag’s terminology also to the leprosy phenomenon. 2. Ober, “Can a Leper Change His Spots?” 173. 3. Kupfer, Art of Healing, 32. 4. Plague hospitals were generally temporary structures, and artistic decorations were limited to simple crucifixes (see fig. 3.1); in addition, all personal items of plague patients had to be destroyed to prevent contagion. Similar considerations may have discouraged decorating leprosaria. On the other hand, depictions of plague scenes appeared in large altarpieces and over city gates to protect the community. The intercession of St. Sebastian and other saints was sought and became noticeable immediately after the Black Death struck. 5. On Nazirites, see Cawley, Alice the Leper, xxiii. On the passage from the separation ceremony, see Roberts and Manchester, Archaeology of Disease, 194. 6. European demographics have only studied in individual regions and periods. Spain and the Scandinavian countries, although not spared the threat of Hansen’s disease, showed comparatively little interest in depicting illnesses in works of art. See Irgens, Leprosy in Norway, 112–14; and Kazda, Ecology of Mycobacteria, 40–43. Unfortunately I have not had a chance to read the article, “Pattern of Leprosy: Deformities among Agricultural Laborers in an Endemic District: A Pilot Study,” Indian Journal of Leprosy (1992): 338. Prof. Irgens kindly answered my email when asked if he had been aware of the significance of boots in leprosy literature; his answer was, “My intention was to account for the falling incidence of leprosy and in that context I mentioned the possibly reduced risk of infection due to protection against environmental mycobacteria by using boots instead of walking barefoot. Obviously the people did not use boots to protect them against leprosy but for many other good reasons! Thus this is hardly a parallel to your interesting piece of information (which I was not aware of) on use of shoes, which apparently was directly associated with leprosy.” Empirical medicine frequently reversed cause and effect.

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NY: Cornell University Press, 2005. Roberts, Charlotte A., Mary E. Lewis, and K. Manchester, eds. ἀ e Past and Present of Leprosy: Archaeological, Historical, Palaepathological and clinical approaches; Proceedings of the International Congress on the Evolution and Paleoepidemiology of Infectious Diseases 3, University of Bradford, 26–31 July, 1999. Oxford: Archeopress, 2002. Rosenberg, Jacob. Rembrandt. 2 vols. Cambridge, MA: Harvard University Press, 1948. Rousselot, Jean. Medicine in Art: A Cultural History. New York: McGraw-Hill, n.d. Rubin, Miri. Corpus Christi: ἀ e Eucharist in Late Medieval Culture. Cambridge: Cambridge University Press, 1991. Safarik, Eduard A., and G. Milatoni. Domenico Feti: Catalogue raisonné. Milan: Electa, 1990. Schawe, Martin. Alte Pinakothek: Altdeutsche und Altniederländische Malerei. Ostfildern: Hatje Cantz, 2006. Schiller, Gertrud. Iconography of Christian Art. 2 vols. Greenwich, CT: New York Graphic Society, 1971–72. Schilling, Edmund. Drawings by the Holbein Family. New York: Macmillan, 1955. Schiro, Giuseppe. Der Dom von Monreale: Die Stadt des Goldenen Gotteshauses. Palermo: Mistretta editore, 2000. Schmidt, Gerhard. “Internationale Gotik in Mitteleuropa.” Kunsthistorisches Jahrbuch Graz 25 (1990): 34–49. Schramm, Percy Ernst. Kaiser, Rom und Renovatio: Studien und Texte zur Geschichte des romischen Erneuerungsgedankens vom Ende des karolingischen Reiches biz zum Investiturstreit. Leipzig: B. G. Teubner, 1929. Schwartz, Gary. Rembrandt: His Life, His Paintings; A New Biography with All Accessible Paintings Illustrated in Color. New York: Viking, 1985. Seppelt, Franz E., and Georg Schwaiger. Geschichte der Päpste. Berlin: Deutsche Buchgemeinschaft, 1964. Silver, Larry. “God in the Details: Bosch and Judgment(s).” Art Bulletin 83, no. 4 (2001): 626–50. ———. Hieronymus Bosch. New York: Abbeville Press, 2006. Snyder, James. Medieval Art: Painting, Sculpture, Architecture 4th–14th cent. New York: Prentice Hall, 1989. Soler del Campo, Alvaro. Art of Power: Royal Armor and Portraits from Imperial Spain. Exhibition catalog. [Madrid]: Sociedad Estatal para la Acción Cultural Exterior; Washington, DC: National Gallery of Art, 2009. Spigelman, Mark, and Helen Donoghue. “Unusual Pathological Condition in the Lower Extremities of the Skeleton from Ancient Israel.” American Journal of Physical Anthropology 114, no. 1 (2001): 92–93. Steffens, A. “Die alten Wandgemälde auf der Innenseite der Chorbrüstungen des Kölner Domes.” Zeitschrift für Christliche Kunst 15 (1902): 129–298. Stoll, Ulrich. Die “Lorscher Arzneibuch”: Ein medizinisches Kompendium des 8. Jahrhunderts (Codex Bambergensis Medicinalis 1): Text, Übersetzung und Fachglossar. Sudhoffs Archiv, Beihefte 28. Stuttgart: Franz Steiner Verlag, 1992. Stone-Ferrier, Linda. Dutch Prints in Daily Life: Mirrors of Life or Mask of Morals? Lawrence: Spencer Museum of Art, University of Kansas, 1983. Terrien, Samuel. ἀ e Iconography of Job through the Centuries: Artists as Biblical Interpreters. University Park: University of Pennsylvania Press, 1996. Toellner, R., ed. Lepra: Gestern und Heute. Münster: Verlag Regensberg, 1992.

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Touati, François-Olivier. Maladie et société au moyen Age: La lèpre, les lépreux et les léproseries dans la province ecclésiastique de Sens jusqu’au milieu du XIVe siècle. Paris: de Boeck Université, 1998. Träger, Jörg. Der reitende Papst: Ein Beitrag zur Ikonographie des Papsttums. Munich: Schnell and Steiner, 1970. Triumph at Carville: A Tale of Leprosy in America. Written and produced by John Wilhelm, Sally Squires, and Michael Tolaydo. DVD, PBS Home Video, 2005. Trnek, Renate. ἀ e Picture Gallery of the Academy of Fine Arts in Vienna: An Overview of the Collection. Vienna: Böhlau, 1985. Tümpel, Christian. Rembrandt/Christian Tümpel: Avec des contributions d’ Astrid Tümpel. Translated by J. et Jean Duvernet, et al. Paris: A. Michel, 1986. Veldman, Ilja M., and H. J. de Jonge. “The Sons of Jacob: The Twelve Patriarchs in Sixteenth-Century Netherlandish Prints and Popular Literature.” Simiolus 15 (1985): 176–96. Vicchio, Stephen, and Lucinda Dukes Edinberg. ἀ e Sweet Uses of Adversity: Images of the Biblical Job. Collegeville, MN: St. John’s University Press, 2002. Vida, Maria. “Die Heilige Elisabeth und die Betreuung der Aussätzigen in den Legenden und den ikonographischen Andenken des mittelalterlichen Ungan.” Orvostörténeti Közlemények/Communicationes de historia artis medicinae 133–40 (1991– 92): 49–65. ἀ e Videodisc Encyclopedia of Medical Images. Princeton, NJ: Films for the Humanities and Sciences, 1992. Virchov, Rudolf. “A Painting of Lepers by Hans Holbein the Elder.” In “The Arts in Dermatopathology,” edited by Warren Dotz. American Journal of Dermatopathology 6, no. 4 (1984): 377–78. Voragine, Jacobus. ἀ e Golden Legend: Readings on the Saints. Translated by William Granger Ryan. 2 vols. Princeton, NJ: Princeton University Press, 1993. Waal, Henri van de. Iconclass: An Iconographic Classification System. Amsterdam: North Holland Publishing, 1973. Watts, Sheldon. Epidemics and History: Disease Power and Imperialism. New Haven, CT: Yale University Press, 1997. Weitzmann, Kurt. ἀ e Byzantine Octateuchs. Princeton, NJ: Princeton University Press, 1999. Williamson, Paul, ed. ἀ e Medieval Treasury: ἀ e Art of the Middle Ages in the Victoria and Albert Museum. 3rd ed. London: Victoria and Albert Museum, 1998. Wilson, Adrian, and Joyce Lancaster Wilson. A Medieval Mirror: “Speculum humanae salvationis,” 1324–1500. Berkeley: University of California Press, 1984. Yawalkar, S. J., M.D. Leprosy for Practitioners. Bombay: Popular Prakasha, 1967.

About the Author Born in Vienna, Austria, Christine M. Boeckl studied art history and classical archaeology at the University of Vienna (Kunsthistorisches Institut). Emigration from Europe to the United States delayed the completion of her studies. She received her doctorate in 1990 at the University of Maryland, College Park. Dr. Boeckl taught art history for twenty years. She recently retired from the University of Nebraska as professor emerita and returned to her family in the Washington, DC, area, where she continues to publish numerous art historical articles in international journals. She is the author of another interdisciplinary book, Images of Plague and Pestilence (Truman State University Press, 2000).

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Index Bold indicates an image

A

Aaron Gives Directions Concerning a Leper (Octateuch Vatican 747), 72 Aaron the Levite, 72 Abbey of St. Denis, 62, 98, 119, 120 Acta Sanctorum (Acts of the Saints), 6, 89 Acts of Sylvester (Vita beati Silvestri), 81, 108 ἀ e Adoration of the Golden Calf (Sistine Chapel fresco; Rosselli), 134 Adoration of the Magi (altarpiece; Bosch), 150 Aegidius (St. Giles), 78, 79, 80 ἀ e Agony in the Garden (Sistine Chapel fresco; Rosselli), 134 Albucassis (Islamic surgeon), 59 Alexander II (pope), 48 Alice of Schaerbeek, Lady, 51, 52, 53, 201n17 American Journal of Dermatology, 128 Amicus and Amelius (poem), 52 Andrews Diptych (Christ Healing a Leper), 75–76, 76 Annual Leprosy Inspection (Nürnberg woodcut), 26, 27, 65–66, 150 Anthony the Abbot (saint), 78, 80 Antiquities of the Jews 9.10 (Flavius Josephus), 28, 73, 151–52 “A Painting of Lepers by Hans Holbein the Elder” (Virchov), 128 Aretaeus of Cappadocia, 24, 97 Arius and Arianism, 108, 208n3 Ars Medica (exhibition catalog), 158 ἀ e Art of Healing: Paintings for the Sick and the Sinner in a Medieval Town (Kupfer), 3–4 ἀ e Art of Power: Royal Armor and Portraits from Imperial Spain (exhibition), 147 Atharva Veda (Sanskrit hymns), 18

Aurenhammer, H., 4 Avicenna (Persian physician), 37, 59

B

Balathal, India, 166 Baldwin IV (king of Jerusalem), 48, 50, 51, 52, 55, 56, 57, 62 ἀ e Baptism of Christ (Sistine Chapel fresco; Perugino), 133 Barbara (saint), 126 Barlaam (saint), 78 Barockthemen (Pigler), 5 Bassus, Junius, 25, 198n5 Bax, Dirk, 147 Beauvais, Vincent de, 69 Beggar (engraving; Van der Velde), 160 Belshezzar’s Feast (Rembrandt), 157 Benedictine Abbey of Reichenau (Augia), 99–100 Benedict Of Nursia (saint), 52, 81, 83 Benedict XII (pope), 49 Benetius (saint), 81 ben Israel, Manasseh, 157 Benitius, Philip, 85, 89 Benizzi, Philip, 85, 89 Bernward of Hildesheim (bishop), 99 ἀe Betrayal (Sistine Chapel fresco; Rosselli), 134 Biblia Pauperum (Pauper’s Bible), 73 Biblioteca Sanctorum (reference book of the saints), 6, 206n32 Binford, Chapman H., 3, 9 ἀ e Birth of Moses (lost Sistine Chapel fresco), 134 ἀ e Birth of Purgatory (Le Goff), 6 Black Death, 38, 46, 198n9, 199n25. See also bubonic plague Blunt, Anthony, 145 Boeckler, Albert, 98 Bol, Ferdinand, 158

225

226  Bonaventure (saint), 85 Boniface (saint), 48 Bosch, Hieronymus, 145, 146, 147–48, 149, 150, 160, 211n26 Botticelli, Sandro, 134, 135 Brody, Samuel, 3 bubonic plague, 38, 46, 54, 55, 61, 123, 131, 157, 161, 199n25, 209n23 Buklijas, T., 128 ἀ e Byzantine Octateuchs (Weitzmann), 4, 71–72, 203n6

C

Cagots of Béarn (Géstains), 49–50, 144 ἀ e Calling of the First Apostles (Sistine Chapel fresco; Ghirlandaio), 133 “Can the Leper Change His Spots?” (Ober), 4, 143, 211n14 Capella di San Silvestro (Santi Quattro Coronati), frescos of, 110–15, 112, 114, 115 Carloman (son of Charles II the Bald), 97 Carolingian renaissance. See Christological cycles; Codex Aureus of St. Emmeram Carus, Lucretius, 24, 26, 197n3 Cathedral of Cologne, 115–17, 118 Cathedral of Košice, Slovakia, 122 Cathedral of Monreale mosaics, 77, 77, 102, 103, 104, 208n27 Cawley, Fr. Martinus, 48, 51, 164, 201n17 Charlemagne, 94–95 Charles II the Bald (Carolus Calvus), 5, 30, 32–33, 95–98, 105. See also Codex Aureus of St. Emmeram Charles V (Holy Roman Emperor), 49 Chauliac, Guy de, 38, 46, 129, 199n25 Chirurgia of Roger Frugard (Guido de Arezzo), 55 Christ Crowning William II (Monreale mosaic), 102 Christ Handing the Law to St. Peter and a Scroll to St. Paul (Capella San Silvestro), 110 Christ Healing a Leper (Andrews Diptych), 75–76, 76 Christ Healing a Leper (Monreale mosaic), 77, 77, 102, 103, 104

Images of Leprosy Christ Healing a Leper (Ottonian miniature), 34, 36, 100–101, 135, 135, 143 Christ Healing a Leper (Sistine Chapel fresco), 132, 133, 133, 134, 135 Christ healing a leper, depictions of. See also Codex Aureus of St. Emmeram about, 73, 74–78, 92, 105 Andrews Diptych, 75–76 Monreale mosaic, 77, 102, 104 Ottonian miniature, 100–101, 135, 143 Sistine Chapel fresco, 132, 133, 134 Christological cycles. See also Codex Aureus of St. Emmeram; Ottonian book illumination Carolingian renaissance, 30, 32–33, 36–37, 41, 42–43, 47, 75, 90, 92–93, 93–98, 165 Christ healing a leper as subject in, 32, 34, 75, 92, 99, 100, 105 depiction of misericordia in, 30–33, 42, 90, 105 Norman cycles, 101–6 Ottonian cycles, 98–101 political significance of art in, 92–93, 94 Christ Preaching (Sistine Chapel fresco; Perugino), 133 Church of St. George mural (ReichenauObernzell), 99 Church of St. Michael in Hildesheim bronze column, 99 ἀ e Circumcision of Moses’ Son (Sistine Chapel fresco; Perugino-Pinturicchio), 134 Cistercian abbey at Cadouin, 39, 40, 80 Codex Aureus of St. Emmeram, about, 30–36, 95–98 Christ and the Fallen Woman, 95, 96 Christ Cleansing the Temple, 95, 96 Christ Healing a Leper (cover), 30, 31, 32, 33, 42, 95, 97, 207n7 Christ Healing a Leper (illuminated folio), 33–36, 34, 36, 41, 42, 97 Christ Healing the Blind, 96–97 Coiter, Volcher, 150 concomitance, 53, 54, 55, 202n21, 202n24

Index Conner, Daniel H., 3, 6, 9, 30, 32 Constantine I (emperor), 81, 81–82, 82, 90, 98, 99, 106, 108–9, 205n25, 208n4 Constitutum Domini Constantini Imperatoris. See Donation of Constantine Conti (cardinal), 114 A Corpus of Rembrandt Paintings (Rembrandt Research Project Foundation), 151, 152–53, 155, 156 Corvinus, Matthias (King Matthew of Hungary), 60 Cosmos (saint), 78, 137, 138, 140, 144, 145 Council of Lyons (1245), 114 Council of Trent, 53, 54, 55 ἀ e Crippled and the Sick Cured at the Tomb of St. Nicholas (Gentile da Fabriano), 61, 62, 63, 79, 203n34 ἀ e Crossing of the Red Sea (Sistine Chapel fresco; Rosselli), 134 ἀ e Crucifixion (Sistine Chapel fresco; Rosselli), 134

D

Dagobert I, king of Austrasia, 120 Damien (saint), 78, 137, 138, 140, 144, 145 Damien of Molokai, Fr. (saint), 22–23, 52, 89–90, 206n35 Dan (biblical patriarch), 153, 154, 155 Dance of the Dead (danse macabre) tradition, 123 Das Lorscher Arzneibuch (early medieval manuscript), 29 de Arezzo, Guido, 55 de Beauvais, Vincent, 69 de Gheyn II, Jacques, 153, 154 de Groot, C. Hofstede, 156 Della Rovere, Francesco (Pope Sixtus IV), 132 Delphine of Glandèves, 87 del Sarto, Andrea, 89 Demaitre, Luke, 3, 13–14, 38, 59, 65 De rerum natura (Lucretius), 24 Die Geschichter der Päpste (Seppelt and Schwaiger), 5 “Die Heilige Elisabeth und die Betreuung der Aussätzigen in den Legenden” (essay; Vida), 60, 62

 227 ἀ e Disease of the Soul: Leprosy in Medieval Literature (Brody), 3 Dives and Lazarus parable, 39, 40, 80 Doctor’s Visit to a Plague Victim (Venice woodcut), 16, 26 Donation of Constantine (Constitutum Domini Constantini Imperatoris), 5, 81, 81–82, 82, 98, 99, 101, 105–6, 110–15, 112, 114, 115, 116–17, 118, 208n5 Donoghue, H. H., 19 Double Portrait with Richildis (Charles II the Bald), 97

E

Eisler, Robert, 151, 155 “elephantiasis” as medical term for leprosy, 29, 43–44 Elisha (prophet), 73, 137, 138, 139–40, 144 Elisha Refusing the Gifts of Naaman (Grebber), 158 Elizabeth of Hungary/Thuringia (saint) “Die Heilige Elisabeth und die Betreuung der Aussätzigen in den Legenden” (essay; Vida), 60 as intercessory saint, 6, 52 life of, 85 St. Elizabeth Bathes a Leprous Patient (painted panel), 60–62, 61, 122–23 St. Elizabeth Cathedral, Košice, Hungary, 60–62, 61 St Elizabeth Placing a Leper in Her Husband’s Bed (painted panel), 124, 125 St. Elizabeth’s Deathbed (painted panel), 124 St. Elizabeth’s Eviction from the Wartburg (painted panel), 124, 126 St. Elizabeth’s of Hungary Dispensing medicine to a Leprous Beggar (fresco), 128–29 St. Elizabeth’s with ἀ ree Male Petitioners (painted panel), 126, 127, 128 St. Elizabeth with a Leprous Beggar (engraving; Israel van Meckenem), 85, 86

228  Elzéar of Sabran (saint), 81, 85, 87–89, 88 Emperor Constantine Struck with Leprosy (fresco; Capella de San Silvestro, Rome), 81, 81–82, 82 Engebrechtsz, Cornelius, 73, 74, 136–45, 137, 138, 141, 142 Epidemics and History: Disease, Power and Imperialism (Watts), 3 ergotism (St. Anthony’s Fire), 131 Ettlinger, L., 132 Eusebius of Caesarea, 108 Eusebius of Nicomedia, 108

F

Fabiano, Gentile da, 61, 62, 63, 64, 79, 203n34 Farovic-Ferencic, S., 128 Feldbuch der Wundtartzney (Gersdoff), 57 Field of Blood cemetery (Jerusalem), 19 ἀ e Fight over the Body of Moses (Sistine Chapel fresco; Signorelli), 134 First Bible of Charles the Bald (portrait), 97 First Council of Nicaea, 108 Four Regents of the Leprooshuis (Bol), 158 Fourth Lateran Council, 5, 48, 49 Francis of Assisi (saint), 52, 59, 81, 83–85, 89 Frederick II (emperor), 114, 115 Frederick II (Holy Roman Emperor), 51, 98 Frederick of Austria, 116

G

Galen, 29 Gallinek, Patricia, 6, 15 Gehazi (Elisha’s servant), 71, 139, 140, 142, 144 George (saint), 79, 80, 205n20 Gerbert of Aurillac (Pope Sylvester II), 99 Gersdoff, Hans von, 57 Gerson, Horst, 151 Géstains (Cagots of Béarn), 49–50, 144 Ghirlandaio, Domenico, 133, 134 Gibson, Walter S., 137, 139, 140, 141, 142, 144, 145 ἀ e Gift of the Keys (Sistine Chapel fresco; Perugino), 133 Giles (Aegidius) (saint), 78, 79, 80

Images of Leprosy Global Project of the History of Leprosy, 15 Golden Legend (Voragine), 6, 62, 69, 85, 105, 124 Gorden, Bernard, 37 Gospel Book of Otto III. See Ottonian book illumination Great Interregnum, 115–16 Grebber, Pieter de, 158 Gregorian Reform, 101, 105, 107 Gregory I (pope), 93, 124 Gregory II (pope), 48 Gregory IV (pope), 95 Gregory IX (pope), 85 Gregory V (pope), 99 Gregory VII (pope), 101, 105 Gregory XI (pope), 132 Grön, K., 4

H

Hamilton, Bernard, 50 Handbook of Leprosy (Jopling), 3 Hansen, Gerhard Henrik Armauer, 7, 22 Hansen’s Disease. See leprosy Head of Young Man (Jeune Lépreux) (Hans Holbein the Younger), 41–43, 43, 200n33 Henry IV of Germany, 101 Henry VII of Germany (Henry the Lame), 51, 52, 98 Hertul, Master, 84 Hippocrates, 29 Holbein, Hans the Elder, 124, 126, 127, 128 Holbein, Hans the Younger, 41–43, 43, 127, 128, 200n33 Hugh of St. Victor, 136

I

Iconographie de l’art chrétien (Réau), 4 Iconography of Christian Art (Schiller), 4 “illness as metaphor,” 161, 162 Images of Plague and Pestilence: Iconography and Iconology (Boeckl), 1, 7 The Index of Christian Art, 4 Innocent II (pope), 48 Innocent IV (pope), 113–14, 115 Inspection of Leprous Patients (woodcut), 57, 58

Index Investiture Controversy (1075–1122), 101, 107 Irgens, Lorentz, 3, 20–21

J

James (saint), 148, 150 Jerome (saint), 29 Jeune Lépreux (Hans Holbein the Younger), 41–43, 43, 200n33 Jewish Sacrifice (Sistine Chapel fresco; Botticelli), 135 Joanna of Castile, 147 Job (biblical figure), 25, 25–26, 75–77 John XXII (pope), 49, 116 Jopling, W. H., 3 Josaphat as a Child Meets a Leper and a Cripple (book illumination), 69–70, 70, 203n3 Josephat (saint), 69–70, 70, 78, 203n3 Josephus, Flavius, 28, 29, 73, 151–52, 156, 157

K

Kaiser, Rom und renovatio (Schramm), 5 Kantorowicz, Ernest H., 5, 92–93 King Matthew of Hungary (Matthias Corvinus), 60 ἀ e King’s Two Bodies: A Study in Medieval Political ἀ eology (Kantorowicz), 5 Knüsel, Christopher, 39, 44 Kölnei, Livia, 59–60 Kottek, Samuel, 28 Kupfer, Marcia, 3–4, 49, 80

L

Labors of Hercules (ivory relief panels), 96 Last Judgment (fresco; Capella San Silvestro), 111 Last Judgment Triptych (Bosch), 145, 146, 147 ἀ e Last Supper (Sistine Chapel fresco; Rosselli), 134 ἀ e Last Testament and Death of Moses (Sistine Chapel fresco; Signorelli), 134 Lateran Council III, 5, 47, 48, 49 Lateran Council IV, 5, 48, 49

 229 ἀ e Lawgiving on Sinai (Sistine Chapel fresco; Rosselli), 134 Lawrence (saint), 80 lazar houses (leprosaria), 47, 50, 80, 122–23, 161, 205n22 Lazarus (saint), 26, 39–41, 40, 42, 44, 77–78, 79, 198n6, 205n23 Lazarus Klep, the Leprous Beggar (Rembrandt), 157, 160 Lazarus of Bethany. See St. Lazarus Legendarium (illuminated manuscript; Master Hertul), 84 Le Goff, J., 6 Leo II (pope), 94 Leo IX (pope), 109 Leo X (pope), 49 ἀ e Leper King and His Heirs (Hamilton), 50 Leper Knights: ἀ e Order of St. Lazarus of Jerusalem in England (Marcombe), 5 Lepers Sent out of Camp (Octateuch Vatican 747), 72 “lepra” (Greek word for leprosy), 2, 19, 29, 42–44, 165 Lepra in de Nederlanden, 4 leprosaria (lazar houses), 47, 50, 80, 122–23, 161, 205n22 leprosy (Hansen’s Disease). See also Levitical tradition and bubonic plague, 38, 46, 54, 55, 61, 123, 131, 157, 161, 199n25, 209n23 characteristics of, 8–10, 26 clinical manifestations of, 11, 13, 14, 15–20, 16, 17, 30, 32, 32–36, 33, 34, 36, 37–38, 39–41, 40, 42, 43–44, 50, 52, 59, 61, 63, 64, 68–70, 85, 86, 87, 88, 211n18 and the Crusades, 5–6, 66, 78, 107 diagnosis of, 15–16, 55, 56, 57, 58, 59, 202n29 dress codes for sufferers of, 38–39, 48, 68–70, 87, 158, 159, 211n13 drug therapy and management programs, 13–14 as European cultural phenomenon, 161, 162

230  leprosy (Hansen’s Disease), continued faking leprosy, 27, 65, 131, 148, 149, 150, 158–60, 159, 164, 211n27 functional recovery from, 15–16, 16, 17, 32, 61, 196n14 lepromatous type, 9, 10, 11, 12, 13, 13, 50, 165 photographic studies of, 11, 11–17, 13, 14, 196n10 protective/preventative gestures/postures in depiction of, 26–27, 27, 54, 55, 65–66, 68–70, 166, 198n6 research in, 8–11 transmission of, 10, 53, 62, 165, 195n6, 197n31 tuberculoid type, 9–10, 12, 14, 29, 50, 165 and tuberculosis, 20–22, 131, 197n28 leprosy, history of, 3–6, 20, 23 ancient world, 24–29, 59 continental United States, 22 in early Greece and Rome, 24–25, 25, 46 in early modern Europe, 37–44, 128–30, 161, 162 European Middle Ages, 29–37, 31, 32, 33, 34, 36, 45–47, 59–65, 120, 131, 150–51 in Hawaii, 22–23 Norwegian Leprosy Research Project, 20–21, 21 origins and global spread of, 13–15, 18–23, 165–66, 196n18, 197n31 leprosy and sainthood. See patron saints of leprosy; specific saints leprosy as political metaphor, 94–97, 110, 119, 162–63. See also Donation of Constantine leprosy iconography. See also patron saints of leprosy; secular leprosy imagery; specific saints biblical imagery, 132–51, 133, 135, 138, 141, 142, 146, 149 depiction of miraculous recovery, 74, 90, 129, 134, 135, 135–36, 136–45, 137, 141, 210n6, 210n8 depiction of victims in, 164–65

Images of Leprosy development of, 66–68 lack of, in lazar houses, 163–64 in the Latin West, 67–68, 203n2 literary sources of, 67, 70–78: Byzantine Octateuchs, 4, 71–73, 203n6; New Testament, 73–78, 129; Old Testament, 71–73, 74, 90, 100–101, 137, 137–45, 138, 141, 142, 203n5, 208n23 northern Renaissance, 136–51, 137, 138, 142, 146, 149 signifiers of leprosy, 27, 38–39, 48, 58, 63, 65, 68–70, 70, 84, 87, 88, 129, 134, 135, 135–36, 141, 142–45, 148, 149 southern Renaissance, 132–36, 133, 135 “Leprosy in Literature and Art” (Grön), 4 Leprosy in Medieval England (Rawcliffe), 3, 45, 80 Leprosy in Norway: An Epidemiological Study Based on a National Patient Registry (Irgens), 3, 20–21 Leprosy in Premodern Medicine (Demaitre), 3 The Leprosy Mission, 17, 17 “Leprosy: The Origin and Development of the Disease in Antiquity” (Manchester), 1 Les vitraux narratifs de la cathédralede Chartres (Manhès-Déremble), 117 Levitical tradition, 18, 28, 35, 39, 46–48, 135, 135–36, 158, 159, 161, 208n23 Lewine, C., 132–33 Lexikon der christlichen Ikonographie (Aurenhammer), 4 Life of Constantine (Eusebius of Caesarea), 108 ἀ e Life of St. Francis (St. Bonaventure), 85 Lillium medicine (Gorden), 37 ἀ e Little Flowers (biography of St. Francis of Assisi), 84–85 Louis IV of Bavaria, 116 Louis IX of France (saint), 52, 85, 89 Louis XIV of France, 49 Lowden, John, 4 Lucretius Carus, 24, 26, 197n3

Index

M

Magnus, Albertus, 10 Major, James, 147 Mâle, E., 4 Manchester, Keith, 1, 3, 19, 39, 44 Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases (Mandell, Douglas, and Bennett), 3, 10 Manhès-Déremble, Collette, 117 Man in Oriental Costume or King Uzziah Stricken with Leprosy (Rembrandt), 151–53, 152, 155–58 Mannerist period in European art, 137, 137–38, 145–51, 210n11 Mantheo (Egyptian author), 28 Marcombe, David, 4, 5 Martin of Tours (saint), 52, 81, 83 Mary Magdelene (saint), 79, 80 Mary of Burgundy, 147 Master Hertul, 84 Master of the Joseph Sequence (Master of Afflingham), 147–48 Matthew, king of Hungary (Matthias Corvinus), 60 Maximilian I (Holy Roman Emperor), 147 Medicine and Hygiene in the Works of Flavius Josephus (Kotteck), 18 Medieval Art (Snyder), 5 Mellinkoff, Ruth, 139, 144 Mentzer, Raymond, 49 Milani, Aureliano, 54, 55, 123 Miriam (Old Testament prophet), 71 Miriam Becomes Leprous (Octateuch Vatican 474), 72–73 Miroir historial (Vincent de Beauvais), 69 Missal of St. Denis, St. Peregrinus, the Leprous Pilgrim (manuscript), 119–20, 121 Mitchell, Piers D., 50 Mollat, Michel, 109 Monreale mosaic, 77, 77, 102, 103, 104, 208n27 Moses, 71, 72 Moses in Egypt and Midian (Sistine Chapel fresco; Botticelli), 134 Moses’s Hand Becomes Leprous (Octateuch Vatican 747), 71–72, 203n5

 231 Mütherich, Florentine, 95

N

Naaman’s Cure in the Jordan (Engebrechtsz), 73, 74, 90, 129, 136–45, 137, 138, 141, 142 National Hansen’s Disease Clinical Center (Baton Rouge, Louisiana), 22, 197n31 Nativity of Christ (Sistine Chapel fresco; Perugino), 133 Nazarites, 48, 201n9 Nelson, Janet L., 5, 96, 97 Nicholas (saint), 78, 79 Norman cycles, 101–6 Norwegian Leprosy Research Project, 20–21, 21 Nürnberg, Germany, 26, 27, 64–66, 131, 150, 160

O

Ober, W. B., 4, 35, 143, 143, 163, 211n14 Octateuch (Vatican 474), 72–73 Octateuch (Vatican 747), 71–72 Office of the Dead (Separatio Leprosorium), reading of, 48 Otto II of Germany, 99 Otto III of Germany, 48, 99 Otto III Enthroned Between Church and State (folio), 99–100 Ottonian book illumination, 32, 33–36, 34, 36, 41, 42, 48, 98–101, 135, 135, 143

P

Panofsky, Erwin, 5 Park, Katherine, 3 pathognomonic composition, 40, 41, 77, 77, 205n16 Pathology of Infectious Disease (Conner), 3 Pathology of Tropical and Extraordinary Disease: An Atlas (Binford and Conner), 3, 9 patron saints of leprosy. See also Constantine I (emperor); Sylvester (saint); specific saints builders and titular saints of lazar houses, 79–80, 109 canonization of, 78–79

232  patron saints of leprosy, continued depiction of, 80, 81, 81–83, 82, 84, 84–89, 86, 88 and the introduction of Eastern medical knowledge to the West, 78 ministering to the afflicted, 79, 83–89, 86, 87, 89–90 performing miracles, 79, 80–83, 81, 82, 84, 89, 206n30 stories of, as political theology, 5–6, 107–9, 129 as victims of leprosy, 79, 80, 205n21 Paul (apostle/saint), 111, 112 Pauper’s Bible (Biblia Pauperum), 73, 204n9 Peregrinus (saint), 62, 119–20, 121 Perlove, Shirley, 156 Perugino, Pietro, 133, 134 Peter (apostle/saint), 111, 112 Philip Benizzi (saint), 85, 89 Philip the Handsome of Burgundy, 147 Pigler, Andor, 5 plague. See bubonic plague Poor Henry (Der arme Heinrich) (von der Aue), 52 ἀ e Poor in the Middle Ages (Mollat), 109 Prefect Tarquinius Interrogating St. Sylvester; Legend of Sylvester, Constantine and Helena (Cathedral of Cologne mural), 117, 118 ἀ e Presentation in the Temple (Rembrandt), 156 The Princeton Index, 4 Procession of the Lepers on Copper Monday (Visscher), 158–60, 159 ἀ e Punishment of Korah and the Sons of Aaron (Sistine Chapel fresco; Botticelli), 134 Purification after Leprosy (Octateuch Vatican 747), 72

R

Rafi, A., 19 Rawcliffe, Carole, 3, 45, 80 Réau, Louis, 4 Religious Art in France, the Late Middle Ages: A Study of Medieval Iconography and Its Sources (Mâle), 4 Rembrandt, 151–58, 160

Images of Leprosy Rembrandt’s Faith (Perlove and Silver), 156 ἀ e Resurrection and the Ascension (Sistine Chapel fresco; Ghirlandaio), 134 Richildis (second wife of Charles the Bald), 96 Ridley-Jopling disease classification system, 8 Roberts, Charlotte, 3 Rosen, Jakob, 156 Rosselli, Cosimo, 132, 133, 133, 134, 135, 135–36, 160 Rothari, king of the Lombards, 166 Rubin, Miri, 53

S

sainthood and leprosy. See patron saints of leprosy; specific saints Saladin, Sultan of Egypt, 48 San Paolo fiore le mura Bible (patriarchal basilica), 97 Santi Quattro Coronati, frescos of, 110–15, 112, 114, 115 “sara’at” (Hebrew word for leprosy), 18, 19, 29, 35, 36, 37, 71–72, 165 Schiller, Gertrude, 4 Schramm, Percy, 5 Schwaiger, G., 5 Schwartz, Gary, 151, 157 scripture references Gen. 49:16–18, 153 Exod. 4:1–8, 72 Exod. 28:6–29, 156 Lev. 8:1–13, 156 Lev. 13:9–46, 18 Lev. 13:38–39, 72 Lev. 13:45, 35, 105 Lev. 13:45–46, 69 Lev. 13 and 14, 71 Lev. 14:1–32, 72 Num. 5:2–4, 71, 72 Num. 6:8, 164 Num. 6:8–21, 48 Num. 12:9–15, 72–73 2 Kings 5:1–27, 73, 137 2 Kings 5:27, 49, 140 2 Chron. 26:16–22, 73, 151

Index 2 Chron. 26:16–23, 18, 19 2 Chron. 26:20–23, 156 2 Chron. 26:23, 19 Job 2:7, 25–26, 75 Job 2:8, 76 Psalms 13:5, 139 Psalms 52:53, 139 Proverbs 8:15, 95 Matt. 5–7, 134 Matt. 5:17, 101 Matt. 8:1–4, 73, 97, 134 Matt. 10:8, 101 Matt. 26:6–7, 78 Mark 1:40–41, 73 Mark 8:22–26, 96 Mark 14:3–4, 78 Luke 5:12–15, 73 Luke 16:10–26, 39 Luke 17:12–19, 104 John 2:14–17, 96 John 8:3–11, 96 John 11:1–46, 80 Rev. 6:15, 111 Sebastian (saint), 5, 126 secular leprosy imagery. See also leprosy iconography cultural significance of, 158, 162, 163–64 faking leprosy, 159, 159, 160 Last Judgment Triptych (Vienna), 147–48 Man in Oriental Costume or King Uzziah Stricken with Leprosy (Rembrandt), 152, 153, 155–58 as political metaphor, 162–63 signifiers of leprosy in, 155, 160, 163, 212n35 as social conscience signifier, 158, 163, 164 Separatio Leprosorium ritual (reading of the Office of the Dead), 48 Seppelt, F., 5, 115 ἀ e Sermon on the Mount (Sistine Chapel fresco; Rosselli), 132, 133, 133, 134, 135 Signorelli, Luca, 134 Silver, Larry, 156 Simon the Leper (biblical figure), 78

 233 ἀ e Sistine Chapel before Michelangelo: Religious Imagery and Papal Primacy (Ettlinger), 132 ἀ e Sistine Chapel Walls and the Roman Liturgy (Lewine), 132–33 Sixtus IV (pope) (Francesco Della Rovere), 132 Snyder, Graydon F., 100 Snyder, James, 5, 94 ἀ e Song of Moses (Sistine Chapel fresco; Rosselli), 134 Spiegleman, Mark, 19 St. Aignan-sur-Cher lazar house, 80, 205n22 St. Aloysius of Gonzanga (?) Administering the Vaticum to Plague Victims (Milani), 54, 55, 123 Stanford, J., 19 St. Anthony’s Fire, 131, 148 St. Anthony Triptych (Bosch), 148, 211n26 St. Bavo Giving Alms to the Poor and Sick (Last Judgment Triptych) (Bosch), 145, 146, 147, 148, 149, 150 St. Benedict Healing a Leper (mural), 83 St. Catherine’s church, Augsburg, Germany, 126 St. Elzéar Ministering to the Lepers (Anonymous), 87–89, 88 St. Francis Caring for the People in a Leper Colony (illuminated manuscript; Master Hertul), 84 St. John Preaching by the Jordan (Sistine Chapel fresco; Perugino), 133 St. John the Baptist monastery (Israel), 19 St. Lazarus and Dives, 39, 40, 80 St. Martin Healing a Leper (Cseriny Altar, Slovakia), 83, 84 Stone-Ferrier, Linda, 159 ἀ e Stoning of Christ (Sistine Chapel fresco; Perugino), 134 ἀ e Stoning of Moses (Sistine Chapel fresco; Botticelli), 134 Studies in Iconography: Humanistic ἀ emes in the Art of the Renaissance (Panofsky), 5 ἀ e Suffering Job and His Wife (Vatican), 25, 25–26, 76, 198n5

234  Sushruta Samhita (ayurvedic medicine text), 18 Sylvester (saint), 81–82, 90, 108–9, 110– 15, 115–17, 119. See also Donation of Constantine Sylvester Chapel mural (Church of Goldbach on Lake Constantine), 99 Sylvester I (pope). See Sylvester (saint) Sylvester II (pope) (Gerbert of Aurillac), 99 syphilis, 131

T

Tarquinius (Roman prefect), 117, 118 ἀ e Temptation of Christ (Sistine Chapel fresco; Botticelli), 135 Theophano (Byzantine princess), 99 Third Lateran Council, 5, 47, 48, 49 Thomas Aquinas (saint), 134 Thomas Becket (saint), 80 Tomb of the Shroud, 19 Toulouse, France, parliament of, 49 ἀ e Tribute Money (Sistine Chapel fresco; Perugino), 133 Tristan and Isolde (medieval tale), 52 Trnek, Renate, 147 tuberculosis, 20–22, 131, 197n28 Tümpel, Christian, 153, 155

U

Ulrich (saint), 78 Urban V (pope), 87 Uzziah, king of Judah, 18, 71, 73, 151, 152, 153, 155–58

Images of Leprosy

V

Van der Velde, Jan II, 160 Varro, Marcus Terenitus (Varro Reatinus), 26 Via Latina cemetery, Rome, Italy, 75 Vida, Maria, 60, 62 Virchov, Rudolph, 128 Visscher, Claes Jansz the Younger, 158–59, 159 Vita beati Silvestri (Acts of Sylvester), 81, 108 von der Aue, Hartmann, 52 Voragine, Jacopo, 6, 62, 69, 85, 105, 124

W

Walters Art Museum, Baltimore, Maryland, 87 Watts, Sheldon, 3 Weitzmann, Kurt, 4, 71–72, 203n6 William II (king of Sicily), 102, 105. See also Cathedral of Monreale mosaics William of Tyre, 52 William of Tyre Discovers Baldwin IV’s First Symptoms of Leprosy (miniature), 55, 56, 57

Z

Zedechias the Jew, 30, 32–33, 98 Zoticos (Roman official), 109