By Rebecca Rideal
In a curious quirk of history, the epicentre of the Great Plague of 1665 was also the location of London’s primary medieval leprosy hospital. To the likes of Samuel Pepys, Nell Gwynn and Charles II, St Giles in the Fields was London’s largest outer parishes. Close to the capital’s burgeoning playhouses, it was a dirty, disorganised and poverty-stricken suburb of ramshackle tenements (just under 2000 households in total) and narrow streets, containing inns, brothels, butchers, watchmakers, booksellers, beltmakers, justices of the peace and nobility. Cosmopolitan and heavily populated, at its centre was the parish church of St Giles in the Fields, rebuilt in the late 1620s/early 1630s upon the site of the medieval original. For Pepys and his contemporaries, it was a place that became synonymous with plague and the deaths of tens of thousands of Londoners. Yet, turn the clock back five and a half centuries and the area was associated with a very different (although no less devastating) affliction.
In 1118, London and its peripheries would have been as alien to Samuel Pepys as his London would be to us today. For a start, England operated under an entirely different branch of Christianity: Catholicism. The population of London was just 18,000, the original Westminster Abbey was only fifty years old, London Bridge was made of wood, not stone, and there were still over two hundred years to go until the first official case of plague in England. Most significantly, for our story at least, in the early twelfth century, the space that the London parish of St Giles in the Fields would later occupy was a green expanse of open fields and fresh air, well outside the capital. The only sign of habitation came from a newly-built hospital or ‘leprosarium’, that provided sanctuary for ‘lepra’ sufferers, away from the populous of London. Named St Giles, after the patron saint of the sick, it was one of the earliest such hospitals in England and records suggest it was founded by Henry I’s queen, Matilda.
At the time of the hospital’s foundation, the word ‘lepra’ (from the Latin ‘scaly’) was a catch-all term used to describe those suffering from a range of debilitating skin conditions, such as eczema, psoriasis, skin cancer, and what we now understand to be leprosy, or Hansen’s disease (after G H Armauer Hansen, the man to identify the leprosy bacterium in 1873). Unlike pre-modern plague, leprosy was (and is) not actually very contagious. It is believed to spread via repeated close contact with the mouth or nose droplets of an infected person. Once contracted, the symptoms of leprosy can take many years to develop and include(d): disfiguring skin sores, nerve damage to the arms, legs and other extremities, collapsed nose, lesions, damaged voice and blindness (not to mention the unknowable impact such an affliction would have on a person’s mental wellbeing). A chronic rather than a terminal illness, complications owing to damaged limbs, infections, etc., could prove fatal.
Leprosy had had a presence in England since at least the fourth century. But it was during a period of significant population growth across Western Europe, from around 1100 to 1400, that it became an endemic feature of life. There is evidence to suggest that this increase might be connected to the greater movement of people during the Crusades. Whatever the cause, sufferers came from all walks of life – for every Robert the Bruce and Bishop of London, there was a city merchant and travelling pauper. Although the scale of the disease is hard to gauge, however, the Benedictine monk, Matthew Paris, estimated that there were 19,000 leprosariums across Europe by 1200, with 100 in England. Modern research by Carole Rawcliffe has placed the number at 300 (at least) between 1100 and 1350. Crucially, despite the construction of constructing leprosy-specific hospitals, for most of the medieval period, leprosy was not thought to be a disease that could be ‘caught’.
As well as being one of the earliest in England, St Giles was also the first leprosarium associated with London. The capital would grow to have several more: St James (for unmarried women) and Les Loke being two notable examples. What all of these institutes had in common was geography. In keeping with accepted traditions, they were located just outside the city, on major travel routes. St Giles was positioned on the main throughway to London from the west. It sat on eight acres of crown land and consisted of an oratory, offices, and a chapel, with farmland containing pigs, oxen, horse, and cows. The hospital’s fourteen or so patients were cared for by monks and initially sustained by charitable donations from the London parish of Queenhithe.
Closely linked to the crown, in 1299, Edward I ordered that the hospital be placed under the jurisdiction of the Order of Saint Lazarus, a decision that provoked a number of complaints about the way the hospital was administered. Nevertheless, as London developed and the hospital became more established, two officials were appointed by the mayor and aldermen of London to manage revenue and the responsibility for funding the hospital was extended to all London citizens. At its peak, rent gathered by London for the hospital of St Giles totalled £80 per year. Yet it wasn’t just money the citizens of London provided, during the reign of Edward III it was stipulated that St Giles patients must be drawn from the City of London. It was only if there were not enough sufferers within the capital, that the hospital could open its doors to take patients from the County of Middlesex.
Up until the 1970s and 1980s, it was almost taken as given that those suffering from leprosy during medieval times were feared and shunned from society, with their affliction being directly linked to sin. Those within leprosariums were believed to have had minimal physical contact with the outside world and those outside the hospitals were thought to be feared – images from the time show leprosy sufferers carrying bells seemingly in an effort to warn healthy people that they were approaching. The monk, Matthew Paris, wrote how those living outside leprosariums were forbidden from entering public spaces such as inns and churches and were not allowed to eat with, bathe with or even walk close to, healthy persons. Indeed, Edward I issued an edict in 1346 expelling leprosy sufferers from city limits.
More recently, work by historians such as Elma Brenner, Timothy Miller, Rachel Smith-Savage and Carole Rawcliffe, has painted a more nuanced picture of medieval leprosy. Far from being ostracised, their research has revealed that those afflicted with the disease were often the objects of profound sympathy and substantial charity, because they were thought to have been specially selected by God for salvation. Through their terrific suffering, it was believed that those with leprosy endured purgatory on earth and would, therefore, go straight to heaven. As such, hospitals centred on spiritual as well as physical care – along with prayer and worship patients could venture outdoors and participate in gardening and the like.
What’s more, Rawcliffe has argued that the location of leprosariums had little to do with unique isolation (general hospitals were also positioned outside the city proper). Rather, leprosariums were positioned outside towns and cities as landmarks; physical manifestations of civic wealth, religious devotion, and human charity. As Miller and Smith-Savage state, historians have long: ‘…misrepresent[ed] medieval Christianity’s response to leprosy as an attempt to punish the victims of the disease rather than to assist them in their suffering’. Brenner goes further to contend that charitable donations were given to ‘support lepers in a religious vocation’ but that the prayers of those suffering from leprosy were seen to hold greater religious currency and could be ‘particularly efficacious in bringing about the donor’s salvation’. One of the many examples of this is Roger, the Archbishop of York, who gave three hundred marks of silver to be distributed ‘among the lepers, the blind, the lame, the dumb, and the rest of the necessitous, and in the repair of churches and bridges, for the salvation of his soul’. It was only in the fourteenth century that attitudes to leprosy changed.
And this is where we come full circle. The arrival of The Black Death in 1348, and its undeniably contagious nature, led to a fear – for the first time – that leprosy might also spread through miasma (the Galenic idea of ‘bad air’). The unparalleled scale of death wrought by plague had a huge impact on attitudes towards leprosy and disease more generally. Fortunately, leprosy began to die off during the fourteenth century, the cause of which is still debated. By the Reformation it had all but vanished in England. Many former leprosariums morphed into more general hospitals for the sick or were sold off following the dissolution of the monasteries. St Giles was no exception: its buildings (excepting the church) were given to John Dudley, Lord Lisle (later Duke of Northumberland) by Henry VIII. In 1542, a burial ground was annexed to the church which was followed by the appointment, in 1547, of the first parish rector. As London swelled, the village of St Giles grew in tandem and became the parish of St Giles in the Fields. By 1665, it had transformed into an overcrowded London suburb, notorious for its poverty and crime, and the burial place of over three thousand plague victims.
Writing about ‘Epidemic infection’ in 1665, one Richard Braithwaite (who was born in 1588, 29 years after the last case of leprosy in London) demonstrated the close link between leprosy and plague in public imagination, when he compared the practice of writing ‘Lord Have Mercy’ on the doors of plague victims to: ‘That as the Leper in the Old Law was to proclaim his dangerous Infection, by crying out, I am unclean, I am unclean…’
Rebecca Rideal is a historian, television producer, and the author of 1666: Plague, War, and Hellfire. She contributed to documentaries such as Bloody Tales of the Tower, Adventurer’s Guide to Britain, Jack the Ripper: Killer Revealed, Escape from a Nazi Death Camp, and the triple Emmy award winning series David Attenborough’s First Life. She runs the online magazine The History Vault and is studying for a PhD on Restoration London at University College in London.
Follow Rebecca on Twitter: @RebeccaRideal