HOPE FOR THE SICK, SEGREGATION FOR THE

UNCLEAN: MEDIEVAL CHRISTIAN ATTITUDES

TOWARD VICTIMS OF PLAGUE AND LEPROSY
Ellen L. Babinsky

The AIDS epidemic has generated important questions for Christians

as we seek ways to respond to victims of the disease and their families.
One category of such questions is related to our heritage. What has been
the church's response to disease in the past? How have Christian leaders
and laypersons interpreted such tragedies for themselves and for their
constituencies? To explore these questions over the centuries is well
beyond the scope of this essay. Instead, I will attempt to describe the
perspective which shaped the Christian response to victims of the great
plague during the middle of the fourteenth century and compare this
response to the church's attitude toward those who suffered from
leprosy. A study of Christian attitudes toward both victims of plague
and victims of leprosy will, I hope, help us to make some discoveries
about ourselves.
There is general scholarly agreement that the Great Plague, or Black
Death, of 1347 to 1350 was one of the greatest disasters ever to have
fallen on humanity. If there could be a measurement of such disasters
the Black Death would be ranked second only to World War II. 1 Close
to one third of the population perished. 2 Why the disease escalated to
such disastrous proportions has occasioned a good deal of debate and
we can posit two levels of interpretation. One level is a modern
approach which focuses on material evidence and attempts to explain
the catastrophe in light of disease theory and demographic data.
Another level of interpretation is a theological focus which attempts to
interpret the Great Plague in light of God's relation with humanity and
God's role in human history. This second level was the framework
within which medieval Christians sought to ascertain the signs of their
times. We shall turn our attention to the theological realm after a general
review of some modern interpretations.
Recent scholarship has found that the rapid spread of the plague is
not completely accounted for by the presence of rats, although rats
certainly aided its spread. Apparently plague manifested itself in at least
two forms. Bubonic plague infected the lymph system causing dis-
Hope for the Sick 47

colored swelling called a "bubo." The victim of bubonic plague might

certainly die a painful death, but apparently also could recover.
Pneumonic plague which attacked the lungs causing a coughing of
blood, was lethal. Every time a pneumonic plague victim exhaled, the
plague bacilli would be sprayed out into the air. It is believed that
bubonic and pneumonic plague were related to each other so that one
could evolve from the other. Thus it seems that the plague was a
virulent, lethal, airborne disease which also helps to account for its
rapid spread, but not entirely. If rats were part of the daily life in the
medieval period, so were airborne diseases.
Another explanation for the rapid spread rests on the susceptibility
of the population. According to one opinion, in the twelfth and thir-
teenth centuries. Western Europe had experienced a rapid increase in
population. Food production was unable to increase with equal speed,
the consequence of which was widespread malnutrition which con-
tributed to the susceptibility of the people to the plague. In this view
the plague can be seen as a natural consequence of demographic factors,
and as a natural means of reducing the population to more manageable
proportions. These kinds of explanation are useful to us in getting a
picture of the enormity of the calamity. But because they are modern
in their emphasis, such explanations do not help us to understand
medieval Christian attitudes toward the plague which had no disease
or economic theory on which to base their interpretation. Christian
attitudes were shaped by the medieval theological framework to which
we now turn our attention.
The theological framework within which Christians sought to under-
stand this disaster was predominantly eschatological in that there was
an expectation of the imminent coming of the kingdom of God to be
established on earth for one thousand years before the Last Judgment. 3
The traditional perspective of the church with regard to the coming
kingdom was that first Antichrist must reign, after which the An-
tichrist would be destroyed by Christ and his saints as part of the
establishment of the heavenly kingdom on earth. This thousand year
period prior to the Last Judgment would be a time of peace in which
the Jews would be converted and the rule of the church would extend
to the ends of the earth. 4 The reign of Antichrist, however, would be
heralded by various and numerous disasters, and Christian inter-
preters of the plague years saw the Black Death within this es-
chatological framework. According to the prevailing schema God was
punishing humanity for sin in various ways, one of which was the
plague and its attendant horrors, which would culminate in the reign
of Antichrist, but which in turn was but the prelude to the glorious
future reign of God and peace of the church. Thus the enormous
48 Babinsky

suffering caused by the rampaging pestilence was interpreted as a call

to God's faithful to endure that they might inherit the riches of
heavenly splendor.5 Another type of eschatological viewpoint held that
there would be a last emperor (or king, or pope) who would inaugurate
wondrous and prosperous times on earth before the appearance of
Antichrist. Before the last great ruler came to power, however, there
would be times of severe deprivation and disease, a "sifting" of the
saints to determine who would be a worthy recipient of future rest and
peace.6 Suffering was thus interpreted in light of a coherent divine plan
for humanity. The eschatological interpretations were thus structured
to offer comfort and hope to disasters' victims: "They were meant to
inspire perseverance in faith, hope, and penance . . . . They intended to
give comfort by providing certainties in the face of uncertainty and
must have helped frightened Europeans get about their work."7

Eschatological interpretation of the plague also influenced groups of

laypersons known as the Flagellants. The Flagellants surfaced prior to
the outbreak of plague, but the rapid spread of the dreaded pestilence
most certainly contributed to the growth and popularity of the move-
ment. The Flagellant movement received its inspiration from a so-called
letter from heaven which was published in 1348. This letter was said to
have been written by God and delivered by an angel upon the alter of
the Church of St. Peter in Jerusalem, in the presence of the patriarch.
The appearance was accompanied by a great light in the sky and those
who saw it had thrown themselves on the ground crying "Kyrie
elieson." The message of the letter was straightforward in its warning:
Christians must turn away from sin or God would destroy the world.
Failure to fast on Fridays and worship on Sundays would lead to famine,
tribulation, and persecution from the Saracens.8 The plague was seen
as a clear sign from God that unless believers repented the world would
be destroyed. The motivation of the Flagellants was to bring about that
repentance and the great processions of Flagellants were carried out in
the hope of inducing God to spare the people.9

Each band of two to three hundred Flagellants was commanded by a

lay leader, called a "Master," who imposed penances and granted
absolutions to the members. Each person who joined a Flagellant group
had to swear absolute obedience to the master for the duration of the
procession of thirty-three days which imitated the number of Christ's
years on earth. The members of a Flagellant band were subject to
rigorous discipline. They were not to bathe, or change their clothes, or
sleep in soft beds during the period of the procession; they were not to
speak except with permission of the master. Above all, complete
abstention from sexual relations was required.10
Hope for the Sick 49

The procession of a band of Flagellants was usually in a long line of

men walking in pairs, women at the end. The marchers were silent,
except for an occasional chant, their faces hidden by cowls and their
eyes fixed on the ground. They were dressed in long black robes with
red crosses on the front and back. Their rituals, attended by great
numbers of townspeople, were held out of doors, usually in the
courtyard of a church. The Flagellants would strip to the waist wearing
only a long skirt and march slowly in a large circle. Each Flagellant
carried a heavy scourge with three or four leather throngs each of which
were tipped with metal studs. With these scourges they began rhythmi-
cally to beat themselves, while the master walked among the people
urging them to pray to God to have mercy on all sinners. The pace
would quicken as each Flagellant strived to attain greater heights of
suffering. Meanwhile the onlookers groaned and sobbed and chanted,
some falling to the ground in a kind of ecstatic faint. 11

Although there was the general attitude that the plague was part of
God's divine plan, either as the herald of the reign of Antichrist or as
punishment for sin, Jews were often identified as the ones who caused
the plague by poisoning the wells. Resident Jews in the urban areas had
often been the targets of suspicion, and the fear of the plague made use
of this generalized suspicion to the extent that if the Jews were
eliminated the plague would be stopped. Widespread persecution and
massacre of Jews by ordinary Christian folk was encouraged by the
Flagellants during the plague years. 12 Pope Clement VI condemned the
Flagellants for their part in encouraging the persecution, and he
publicly threatened excommunication of those who participated in the
persecutions. Rulers and some town councils tried to stop the pogroms,
but their efforts did little to stem the bloody tide against the Jewish
population and thousands died. 13

The fact that Jews were blamed for the plague and thus mercilessly
persecuted as the scapegoat indicates that even the most carefully
constructed theological interpretation designed to instill hope and
encouragement was not wholly satisfactory for ordinary Christians. For
these folk, it was still somehow important to lay blame in concrete
fashion for the otherwise unexplainable devastation and chaos which
had descended upon them. Without diminishing the cruelty inflicted
upon the Jews as a result, it is also important to recognize that in
searching for someone to blame, those who fell ill with plague were not
blamed. The individual victims themselves were not held responsible
for their affliction as were the lepers throughout the medieval period.

Segregation of lepers has roots going back at least as far as proscrip-

tions in the Old Testament; "The leper who has the disease shall wear
50 Babinsky

torn clothes and let the hair of his head hang loose, and he shall cover
his upper lip and cry. Unclean, unclean.' He shall remain unclean as
long as he has the disease; he is unclean; he shall dwell alone in a
habitation outside the camp" (Lev. 13:45-56, RSV). In the last quarter
of the twelfth century the Third Lateran Council decreed what was
already practiced, that lepers should be segregated and were forbidden
to go to church or to be buried in the same cemeteries with those who
had been free of the disease. 14 The promulgation of this decree underlay
the increased foundations of houses and hospitals for lepers. The
motivations behind such foundations may have included a compas-
sionate concern for the treatment of lepers, but it also included a rising
hostility toward them and the conviction that victims of the disease
should be segregated. 15 Segregation of lepers was reinforced by a ritual
of separation which was modelled on the rite for the dead. The leper
was required to stand in an open grave while the words were solemnly
intoned by the priest:

I forbid you ever to enter the church or monastery, fair, mill,

market-place or company of persons . . . ever to leave your house
without your leper's costume . . . to wash your hands or anything about
you in the stream or fountain . . . . I forbid you, if you go on the road
and you meet some person who speaks to you, to fail to put yourself
downwind before you answer . . . . I forbid you ever to touch children
or give them anything. I forbid you to eat or drink from any dishes but
your own. I forbid you to eat or drink in company, unless with lepers. 16

In addition to the leper's death to the world of society, was the

deprivation of rights of property to one degree or another. In some
areas, the leper was allowed to retain the income from property. In
other areas, the leper was forbidden either to inherit or to make out a
will. 17 By means of various kinds of legislation, the image was rein-
forced that the leper was the most repellent creature, the lowest degree
of human degradation. It can be argued, therefore, that although there
may have been some charitable motivation in the founding of leper
houses, the abundance of legislation pertaining to segregation of lepers
indicates that such segregation and the institutions founded to imple-
ment segregation were primarily social and not solely charitable and
medical measures. That is to say, that the leper was viewed as a threat
to the social equilibrium, and segregation was the way to maintain the
delicate balance.

The picture which seems to emerge regarding the medieval period is

that intellectual energy was expended in the effort to interpret the
plague within the eschatological framework of God's divine plan. No
such effort seems to have surfaced with regard to the leper; rather, the
Hope for the Sick 51

leper seems to have been a "socially accepted" outcast. That is, there
seems to have been no felt need to explain why persons were lepers.
Moreover, proscriptions with regard to inheritance for lepers seem to
imply that lepers were somehow responsible for their condition, that
the privilege of owning property was for those who were "clean." In
this context Robert I. Moore cites the observation that diseases which
defy scientific explanation tend to be viewed as symbolic of and
punishment for the weakness of their victims, and he notes that AIDS
is a clear example in our time. 18 From this brief study, however, it would
appear that this comparison is in some ways a false one; with regard to
medieval society we are not comparing attitudes toward two kinds of
diseases. Instead we seem to have on the one hand a clear case of how
people viewed a disease of epidemic proportions in the plague, and on
the other hand the murkier subject of how a society maintained the
boundaries of taboo. Treatment of lepers as a function of taboo is an
area which remains unexplored, and must remain so in this essay.
Nonetheless, as a result of attempting to compare attitudes toward
victims of plague and victims of leprosy in the medieval period, I am
left with the possibility that in our struggle to respond effectively and
compassionately to victims of AIDS and their families we are in fact
struggling with a late twentieth-century social taboo structure. If this
possibility has any merit at all, then we have a monumental task before
us. Our enemy is less a disease than our apparent inability to overcome
ourselves.

Footnotes
1
Robert E. Lerner, "The Black Death and Western European Eschatological
Mentalities," Amerìcan Historical Review, 86:533.
2
Norman Cohn, The Pursuit of the Millennium, (New York: Oxford University
Press, 1970) p. 131.
3
Lerner, "Eschatological Mentalities," p. 537.
4
Lerner, "Eschatological Mentalities," p. 540.
5
Lerner, "Eschatological Mentalities," p. 542.
6
Lerner, "Eschatological Mentalities," pp. 544-550.
7
Lerner, "Eschatological Mentalities," p. 551, 552.
8
Gordon Leff, Heresy in the Later Middle Ages: The Relation of Heterodoxy to
Dissent c. 1250-c. 1450, vol. 2 (New York: Manchester University Press, 1967),
pp. 488-89.
9
Ziegler, The Black Death, (New York: Harper & Row, 1969), p. 88. See also
Lerner, "Eschatological Mentalities," p. 537.
52 Babinsky

10
Norman Cohn, Pursuit of the Millennium, p. 133.
11
Ziegler, pp. 89-90.
12
Leff, Heresy in the Later Middle Ages, p. 490.
13
Ziegler, The Black Death, pp. 97-109.
14
Robert I. Moore, The Formation of a Persecuting Society, (Oxford: Basil
Blackwell Ltd., 1987) p. 51.
15
Moore, p. 54.
16
Moore, pp. 58-59.
17
Moore, pp. 59-60.
18
Moore, p. 80, cites Susan Sontag, Illness as Metaphor, (New York, 1978).
 ^ s
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