It is fair to say that Carole Rawcliffe has written the definitive study of leprosy in medieval England. Comprising more than 350 pages of text with illustrations, this meticulously researched work explores the topic from every imaginable angle by exploiting an impressive array of evidence. Rawcliffe explodes modern myths about the treatment of lepers in the Middle Ages, some of which were constructed to bolster modern agendas, and the result is a book that should have broad appeal to modern as well as medieval historians.

After a brief introduction, Rawcliffe launches into a discussion of the misuse of the medieval evidence by late nineteenth- and early twentieth-century politicians, bureaucrats, and missionaries concerned with the outbreak of epidemic disease in their own time. The science of microbiology was in its infancy, and the debate between the so-called “hereditary” and “contagion” theories continued to rage. The cause of the “contagionists” was furthered by the death in 1899 of a Belgian missionary working among lepers in Hawaii, and calls for strict segregation, medieval-style, soon followed. Rawcliffe artfully explores how the contagionists embellished the slim evidence for forced segregation in the Middle Ages to justify their own political agendas. Modern missionaries further perpetuated myths associating the disease with moral decay supposedly based on medieval attitudes, attitudes that were, in fact, far more complex. The inability of medical science to offer definitive answers only contributed to what Rawcliffe calls an “explosive brew of racialism, social Darwinism, imperialism and religion” (25). Unfortunately, modern historians carried some of these views into the late twentieth century by relegating lepers to a category of marginal society akin to prostitutes and heretics. Despite, for example, the fact that there is very little evidence that the ritual of exclusion, the so-called Leper's Mass, was ever performed in England, it remains an integral element in modern discussions of the disease and its treatment.

The deconstruction of the mythology of the medieval English leper begins in chapter 2 with an investigation of the presumed causes of the disease. In short, leprosy was considered an act of God that could be interpreted as a reward or a punishment. The connection between leprosy and sin did indeed have a long history, stretching back to the Bible, but so did the competing notion that leprosy was a divine gift given to noble figures like Baldwin IV, king of Jerusalem. The development of the doctrine of purgatory apparently only underscored the usefulness of earthly, Job-like suffering. Thus, Rawcliffe establishes at the outset one of the fundamental paradoxes of the medieval attitude toward leprosy, which is reflected in the frequent depiction of Christus quasi leprosus in literature and iconography. That healthy men and women often sought to tap into the “spiritual assets” of lepers is just one manifestation of medieval society's deep ambivalence toward this disfiguring and painful disease.

A lengthy and detailed examination of classical and medieval ideas about health ends this chapter, although the medical issues are taken up again in two later chapters on the diagnosis and treatment of the disease by physicians, lay and clerical. Suffice it to say that because leprosy was thought to be caused, like most conditions, by an imbalance in the body's humors, physicians sought to restore that balance using a variety of tools, from good nutrition and herbal baths to drugs and surgery. Here Rawcliffe successfully challenges the myth that medieval physicians were naive hacks. From the detailed treatises they had at their disposal to the impressive array of tests they performed, practitioners employed a variety of methods to diagnose and treat the tricky disease before it became necessary for the patient to withdraw from society.

The issue of segregation is, not surprisingly, also considered from several angles. Rawcliffe first addresses it in a chapter on attitudes toward suffering, showing how those who could afford to do so established leprosaria for sick family members and friends. Although most foundations were small, the overall generosity of the English elite is still impressive: some 320 hospitals were founded just for lepers between the eleventh century and the dissolution. Early ties established between leper hospitals and popular saints such as Lazarus, Mary Magdalene, Bartholomew, and Giles guaranteed that donations would continue to be made even when new foundations were no longer being established in large numbers after the 1350s.

Most of these foundations, Rawcliffe argues, were not houses of horror but places of spiritual as well as physical healing. Indeed, the model for the medieval leper hospital was the monastery, and in some cases residents took monastic vows, dedicating themselves to celibacy (not as obvious as one might think in the case of lepers) and participating in the Divine Office. These voluntary foundations, it turns out, were not meant to force lepers out of society but to provide for their special needs. While they did lose rights to inherit property, enter into contracts, and make pleas in court by the thirteenth century, English lepers were never routinely rounded up by zealous officials except in the case of vagrancy. Although some houses were excruciatingly poor, the evidence suggests that there was lively competition for entrance into the best facilities and that healthy people chose to live in them as well.

The last myth that Rawcliffe dispels is that lepers lived totally apart from a society that could not stand to look at them. Some leprosaria were indeed remote, but many occupied strategic positions on roads and waterways to make it easier to attract alms. Still others were prominent features of urban landscapes, funded by local guilds as markers of civic pride. Travelers were provided hospitality, and a host of officials, civic and religious, came and went, underscoring once again the complexity of interaction between the sick and the healthy. In the end, this book is not always an easy read; the level of detail is daunting and the topic is often depressing. But Rawcliffe's compassionate and lively rendering certainly makes it a compelling and worthwhile read.