A decade after the appearance of her study of Images of Plague and Pestilence (Kirksville, Mo.: Truman State University Press, 2000), art historian Christine Boeckl has turned her attention to a disease which stimulated far more complex and ambivalent responses on the part of medieval and early modern artists, theologians, and philanthropists. She begins with a discussion of Hansen's disease (HD), as leprosy is now known, before considering its historiography and the ways in which medieval European society reacted to it.

Having set the scene, she proceeds to examine the emergent iconography of the disease, the depiction of Christ's two healing miracles involving lepers, and the religious and political contexts in which patron saints of the leprous were portrayed. The final chapter deals with the increasing diversity and secularization of imagery after 1450, when leprosy was in retreat. An appendix of sources, largely drawn from the Bible, but including the so-called “ceremony of sequestration,” follows. The striking choice of illustrations is confined to what might be termed “fine art”; none of the images are English, nor do they include “less important artefacts,” such as the seals and banners of leper houses or stained glass, which is contentiously dismissed as “minor art” (80). Yet windows were seen by far more people than were many of the images considered here, and some consideration of a medium so well suited to the demands of ecclesiastical propaganda would have widened the scope of this survey. The focus is almost exclusively upon high status patrons, and by far the best and most illuminating chapters relate to the political and theological uses of leprosy by popes, emperors, and other prominent figures. The rest of the book is not quite so convincing.

Post mortem diagnosis across the centuries is always risky, especially in the case of a disease as challenging as leprosy. Boeckl is undoubtedly right in suggesting that many of the individuals depicted in the images she has selected were, indeed, victims of HD. But her tendency to equate medieval lepra more generally with HD and to ignore the diverse and constantly shifting ideas about causation advanced between the fourth and the sixteenth centuries creates an oversimplified, sometimes misleading picture. Her penchant for sweeping generalizations over time and place stands in sharp contrast to the chronological and geographical nuance that has become a hallmark of recent research on medieval leprosy. Evidently unaware of François-Olivier Touati's influential articles on the dissemination of ideas about contagion in later medieval Europe, and of his critique of the monolithic approach adopted by earlier generations of scholars, Boeckl assumes that lepers were segregated to protect others from infection throughout the period, even though few ordinary people expressed such fears before the early fourteenth century. Nor is there much sense of the more positive view of the disease as a religious calling or vocation that Nicole Beriou and Professor Touati have so convincingly documented before the 1250s. Far from being integrated into the Christian community, the “reviled” medieval leper (163) who emerges from these pages differs little from the contagious outcast envisaged by nineteenth century missionaries and advocates of forced isolation.

One would have hoped that, after five decades of published research, beginning with that of the distinguished liturgical scholar, A. J. Collins in 1960, belief in the historical reality of “the leper mass” and other gruesome rituals of separation so beloved by Victorian segregationists would have been buried at the crossroads of scholarship with a stake through its heart. Boeckl's efforts to revive the corpse are at best questionable. Disconcerted by her assertion that the Third Lateran Council “prescribed a religious ritual, the Separatio Leprosorum, during which the office of the dead was read over the patient'” (48), which it most certainly did not, this reviewer was astonished to find her own work cited (200n9) as evidence for what can be best described as an utter fabrication. Elsewhere, inconvenient facts are simply ignored. In her anxiety to prove that most cases of medieval lepra must have been HD, Boeckl argues that “miracle healings (sic) of leprous persons were rare” (81). So much, then, for the thirty-one cases recorded by St. Thomas Becket's first hagiographer and the nine added by his second (all within a few years of his martyrdom), along with all the others attributed to any medieval saint worth his or her salt before diagnostic criteria grew tighter in the thirteenth century. Two cures of the leprous by Becket and one by St. William of York were even advertised in stained glass at their respective shrines.

The number of errors and inconsistencies in these pages suggests that the author had little time to check her manuscript and does not reflect well on the editorial standards set by Truman State University Press. A careful editor would surely have spotted that plate 4.8 does not depict Elizabeth of Hungary lifting “the covering” from a leper who gazes “adoringly at the kind princess.” It actually portrays her in the style of the Virgin of Mercy, sheltering him under her elegant robe, while he stares away from her in fear of what we assume to be a hostile world: a far more powerful image that, paradoxically, lends support to Boeckl's thesis. References to a “certain Rudolph Virchov” who made notes on a painting by Holbein in the 1860s (128) might have prompted thoughts of the eminent bacteriologist Rudolph Virchow, while assertions that both “the concept of purgatory” and reverence for “intercessionary saints” began in the 1270s ought, at the very least, to have raised a sceptical eyebrow. Having just been informed that “this contagious disease . . . laid low the whole continent for many centuries” (7), we are confused to learn that ninety-five percent of the population enjoys natural immunity from it (10) and that an even lower rate of infection obtained in early fourteenth-century Bruges (14). Nor are we entirely convinced that leprosy “must have been a notable presence (sic)” in Hungary on the basis of twenty-five known references to leper hospitals between 1082 and 1575: that is one about every twenty years (59). Image and reality did not always march in step.