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The Walking Dead
Challenging the classic image of the outcast leper using the
archaeological burial evidence from English medieval cemeteries. By
Louisa Cunningham
0801268
This dissertation is submitted in part fulfillment of the requirements for the degree of M.A. (or B.Sc) with Honours in Archaeology at the
University of Glasgow
April 2012.
The Walking Dead Challenging the classic image of the outcast leper using the archaeological burial evidence
from English medieval cemeteries.
By Louisa Cunningham, 0801268 Abstract The medieval leper has been referred to as ‘The Walking Dead’, a phrase which took its origin
from ceremonies declaring the leper dead to the world and therefore the walking dead.
Attitudes to the leper are not this straightforward. There is evidence indicating that care was
provided for these diseased individuals in the form of hospitals and that there were medical
treatments available. Lepers were feared and were not full members of medieval
communities but this view is too simplistic to describe the diverse role that the leper played.
Through an analysis of several English cemeteries from the medieval period the evidence and
insights into the treatment of leprous individuals through burial practices were discussed. I
compared leper burials with non‐leprous burials to illustrate that there is no distinction made
between them using disease. There is little evidence from the burial practices to suggest
that these liminal characters were treated with outright disgust and revulsion and there does
not appear to be any strong evidence that there were attempts to differentiate lepers after
death through burial form. I conclude that the burial evidence indicates that medieval
society did not just see lepers as outcasts and simply forget about them but that they held
lepers in higher regard and did not distinguish them through burial practice using their
disease status.
Contents
Acknowledgments……………………………………………………………………………i Figures…………………………………………………………………………………………….ii
1. Introduction…………………………………………………………………………………….1
2. Leprosy……………………………………………………………………………………………3
2.1. Leprosy the disease……………………………………………………………..3
2.2. Diagnosis and treatment………………………………………………………6
3. The social position of the leper……………………………………………………….12
4. Analysis of the cemetery evidence………………………………………………….15
4.1. Hospital of St Mary Magdalene, Chichester…………………………15
4.2. St Margaret’s cemetery, Norwich………………………………………..27
4.3. St Bartholomew’s hospital, Bristol……………………………………….34
4.4. The priory and hospital of St Mary Spital, London………………..37
5. Discussion………………………………………………………………………………………..43
6. Bibliography…………………………………………………………………………………….49
i
Acknowledgements
I would like to thank Professor Steve Driscoll for all his help, guidance and support in writing
this piece of work. I would also like to thank the Archaeology department at the University
of Glasgow for the use of their computer facilities and for the support of the staff. Thanks
also to the University of Glasgow library. Special thanks to my parents who helped me
through all the stress and panics about getting this work finished! Final thanks to my cat Sid
and my dog Jasmine for putting up with and listening to my archaeological ramblings!
ii
Figures
1. Prince Baldwin having his numb forearm pinched by other children and the examination of the forearm by William of Tyre. (Mitchell, 2002:177).
P4
2. Lateral view of a skull from a medieval, adult skeleton diagnosed with leprosy from Denmark. Erosion of nasal margins and loss of the anterior nasal spine. (Manchester, 1983: plate 15).
p4
3. Anterior view of medieval leprous skull from Denmark with resorption of the alveolar process of maxilla with ante mortem loss of central and lateral incisor teeth (Andersen & Manchester, 1992:123).
P5
4. Anterior view of medieval leprous skull from Denmark displaying atrophy of alveolar process of maxilla (arrowed) (Manchester, 1983: plate 14).
P5
5. Tomb 241 with skeletons 115, 88, and 55. ( Magilton et al, 2008:87). p16
6. Matchstick plan of all graves for which an orientation could be recorded with numbered skeletons and with the site subdivided (Magilton et al, 2008:91).
p19
7. The primary graves of area A. Subdivided into columns. M= certain or probable male; F= certain or probable female; ?= undetermined sex; L= leprosy; T= tuberculosis; S= syphilitic lesion (Magilton et al, 2008:95).
P21
8. The intermediate graves of area A. Subdivided into columns. M= certain or probable male; F= certain or probable female; ?= undetermined sex; L= leprosy; T= tuberculosis; S= syphilitic lesion (Magilton et al, 2008:96).
p22
9. The latest graves of area A. Subdivided into columns. M= certain or probable male; F= certain or probable female; ?= undetermined sex; L= leprosy; T= tuberculosis; S= syphilitic lesion (Magilton et al, 2008:97).
p23
10. The primary graves of area B. Subdivided into columns. M= certain or probable male; F= certain or probable female; ?= undetermined sex; L= leprosy; T= tuberculosis; S= syphilitic lesion (Magilton et al, 2008:101).
p25
11. The distribution of individuals with leprosy at St Mary Magdalene (Magilton 2008:105).
p26
12. Map of the hospitals and similar institutions of medieval Norwich (Fay, 2006:195).
p28
13. Grave 480, St Margaret Fyebridgegate (Fay, 2006:199). P30
iii
14. Grave 324, St Margaret Fyebridgegate (Fay, 2006:200). P31
15. Grave 276, St Margaret Fybridgegate (Fay, 2006:203). p32
16. Grave 153, St Margaret Fybridgegate (Fay, 2006: 205). p34
17. Plan of building 1B and the human burials at St Bartholomew’s hospital (Price & Ponsford, 1998:90).
p36
18. Plan of the principal archaeological features of St Mary Spital after the refoundation 1235‐1280 (Thomas et al, 1997:27).
p39
19. Plan of the archaeological features of St Mary Spital, London, c1280‐1320 (Gilchrist, 1995:27)
P41
1
1. Introduction
The medieval leper was often referred to as ‘The Walking Dead’, a phrase which took its origin
from ceremonies declaring the leper dead to the world and therefore the walking dead. Attitudes
to the leper are not as straightforward as this statement might suggest. While the image of the
outcast leper has become synonymous with medieval life, the leper actually held a very unique
position in society as they could be seen as a physical manifestation of the sin within as a source
of revulsion and cast out from normal society, but then simultaneously they could be seen as
recipients of divine grace with the opportunity for redemption. There is evidence to suggest that
these widely differing attitudes both existed in the medieval period. The difficulty is finding the
evidence of these attitudes to support the written sources. Can we see either of these attitudes
reflected in the burial practices that leprosy sufferers received? Through an analysis of the
skeletal and grave evidence at English hospital cemeteries and cemeteries associated with
hospitals, and a comparison between specifically leprous burials and burials of other hospital
inmates I intend to investigate whether lepers received burial treatments that would differentiate
them even after death due to their disease status. I intend to assess whether the leper really was
as feared as the classic image of the outcast leprous individual suggests or were they cared for by
society.
I will begin with a discussion of the disease itself, outlining the effect leprosy has on the
physical appearance of a person and in doing so create an image of what lepers would have
looked like to the rest of society. Following on from this I will outline the diagnostic procedures
and the variety of treatments that were inflicted upon the leper. The presence of this evidence
tells us that the leper was not entirely shunned by society and that there was a provision of care
available. The discussion will then move on to the subject of the social attitudes towards leprosy
that existed in the medieval period. Religion was the major influence and so I shall briefly outline
2
the central beliefs behind medieval Christianity. The religious attitudes to leprosy varied and
changed over time and so I shall focus on the diverse and contrasting views that were expressed.
The second half of this work will focus on the evidence from cemeteries. Using examples
from hospital and non‐hospital cemeteries I will analyse the burial formats of leprous individuals
in comparison with the burials of individuals suffering from other ailments and also supposed
graves of healthy individuals. Due to the lack of archaeological evidence for medieval hospitals
and written evidence for the treatment of lepers in Scotland this study will be limited to English
cemeteries. Throughout this analysis there will be a focus on the importance of whether disease
dictates burial practice, or if social rank, wealth, or economic factors within the cemetery and its
management took precedence. I will finish by drawing this evidence together and discussing the
outcome of the analysis.
3
2. Leprosy
Leprosy was particularly rife during the medieval period and gathered a lot of attention both of a
physical nature and of a religious nature. It is thought that the first written record of leprosy in
Britain is from the 10th century where it is referred to as ‘lepra’ which may or may not be ‘true’
leprosy. True leprosy seems to have become a social problem in the 11th century and then died
out in the 14th century (Magilton et al, 2008:9).
2.1 Leprosy the disease
In order to understand the treatment of lepers in the medieval period it is important to
understand the disease from a modern medical perspective first. There are two main forms of
leprosy; tuberculoid which is a relatively benign strain and can heal at early stages and
lepromatous which is the more severe strain causing the typical disfigurement associated with
leprosy (Rawcliffe, 2006:2‐3). Lepromatous leprosy is a slow moving chronic infection caused by
the bacillus Mycobacterium leprae and is transmitted by either inhalation or direct contact into
an open wound by an infected individual, however it is important to note that most who acquire
the infection have had prolonged contact with infected individuals (Larsen, 1997:104) and that
the incubation period for the disease is very long as it can take years for it to physically manifest.
It is important to be aware of this when analysing skeletons; an individual might have suffered
from leprosy but did not survive long enough for it to affect the bone. The bacteria encounters
very little resistance as it slowly spreads through the body, then gradually is revealed through
systematic nerve and tissue damage (Rawcliffe, 2006:3) with one of the principal stages of the
disease being a loss of sensation due to inadequate innervation which is why sufferers of leprosy
feel no pain when they are inflicted with minor damage to the skin such as cuts and scrapes
(Larsen, 1997:104). This is well illustrated in the historical accounts of King Baldwin IV of
4
Jerusalem (1160‐85) arguably one of the most famous sufferers of leprosy in history. The source
of Baldwin’s leprosy is not known but it is clear that he contracted it at a young age from
someone whom he spent a lot of time with. It was William of Tyre, tutor to Baldwin as a child,
who first recognised the symptoms of leprosy after Baldwin and his friends had been playing a
game involving pinching each other, Baldwin did not react to the pain and when William
examined the boy’s arm (figure 1) he realised it was numb, anaesthesia of the skin was a known
symptom of leprosy (Mitchell, 2000:249‐50). As the disease progresses it begins to manifest
Figure 1: Right. Prince Baldwin having his numb
forearm pinched by other children and
theexamination of the forearm by William of Tyre
(Mitchell, 2002:177).
Figure 2: Left. Lateral view of a skull from a
medieval, adult skeleton diagnosed with
leprosy from Denmark. Erosion of nasal
margins and loss of the anterior nasal spine
(arrowed) (Manchester, 1983: plate 15).
5
Figure 3: Above left. Anterior view of medieval leprous skull from Denmark with resorption of the
alveolar process of maxilla with ante mortem loss of central and lateral incisor teeth (Andersen &
Manchester, 1992:123).
Figure 4: Above right. Anterior view of medieval leprous skull from Denmark displaying atrophy of
alveolar process of maxilla (arrowed) (Manchester, 1983: plate 14).
physically as lesions across the skin which grow waxen and nodular and as leathery ulcerated
areas (Rawcliffe, 2006:3), it is at this stage that we begin to see the disfigurement pattern
typically associated with leprosy. The palate and larynx are usually infected which causes the
voice to grow hoarse and rasping and also causes the nasal cartilage to erode which results in the
collapse of the bridge of the nose, loss of the anterior nasal spine (figure 2) and also resorption of
maxilla leading to the loss of teeth(figures 3 and 4) (Rawcliffe, 2006:3 and Andersen &
Manchester, 1992:123). Following this, various bodily extremities including the nasal tissue and
6
also fingers and toes become disfiguredand in some cases are lost entirely due to the disease
penetrating the bone marrow which weakens the skeletal frame and makes it more liable to
fractures (Larsen, 1997:104 and Rawcliffe, 2006:3), infection then prevents healing and these
body parts are lost. It can take years for the disease to reach this stage of dramatic physiological
distortion, but it is these individuals who were long‐term sufferers of the disease that we see in
the archaeological record through the skeletal changes caused by leprosy. Leprosy is one of the
few diseases that we can identify in skeletal remains. The Danish physician and paleopathologist
Vilhelm Möller‐Christensen carried out research on human remains from medieval leper
cemeteries in Denmark producing an unparalleled record of the effect of the disease on the
skeleton (Larsen, 1997:104). His work revealed a distinctive facies leprosa skeletal syndrome
involving atrophy of the nasal and maxillary regions, alveolar resorption and anterior tooth loss as
well as atrophy and shortening of the hands and feet (Larsen, 1997:105‐6). Cribra orbitalia,
periostitis on tibiae and fibulae and maxillary sinusitis have also been associated with leprosy
although on their own they are not symptomatic (Larsen, 1997:106).
2.2 Diagnosis and Treatment
A key aspect of leprosy, as Rawcliffe (2006:3) summarises, is that it adopts a protean shape which
is likely to vary greatly from one person, generation or locality to the next whether it be in its
benign or malignant form causing problems when it comes to diagnosis. Despite such difficulties
the medieval medical practitioners were still able to identify some of the common symptoms of
the disease some of which are still featured in modern medical textbooks (Rawcliffe, 2006:3).
Much of medieval medical practice relied on Greek humoral theory, which was based on the
premise that the body was made up of four elements, which were the basic elements that make‐
up the universe; fire, water, earth, and air. These corresponded with substances in the body;
humors which are balanced in a healthy individual so diseases and illnesses would cause an
7
imbalance (Gilchrist & Sloane, 2005:222). The four humors were black bile, yellow bile, phlegm
and blood and it was believed that an imbalance of these would not just manifest in the body
physically but would also cause a change in the individual’s personality (Rawcliffe:2006:159).
Certainly it seems that the most widely used diagnostic indicator was the facial and bodily
disfigurement of the individual. There are issues of misdiagnosis with this method however.
There are numerous illnesses that can cause facial disfigurement but which do not leave skeletal
traces, yaws and advanced syphilis for example, which a medieval physician might easily
misdiagnose without our modern diagnostic techniques. It is possible that medieval
diagnosticians loosely grouped and number of ailments under the word “leprosy” (Hays, 2009:22).
It was long believed that treponemal disease or syphilis made its way to Europe and in particular
Britain through Columbus’s crew as a disease picked up from the American Indians and was
brought over to Europe in 1493 (Stirland, 1991:39) but it is now believed to have been present in
pre‐Columbian Medieval Britain and perhaps as far back as biblical times where it is believed to
have been also confused with leprosy (Crane‐Kramer, 2002).
The perceived causes of leprosy in medieval Britain were varied and numerous, among the
components likely to cause the disease were divine will, hostile planetary forces, poor diet,
corrupt air, dirt, sexual misconduct, prolonged contact with the leprous and heredity (Rawcliffe,
2006:4). It is a general assumption that medical practitioners from the medieval period based
their diagnosis on supernatural beliefs which can be seen in some of the factors mentioned above
but prolonged contact with an individual infected with leprosy and heredity are today accepted as
actual causes for contraction of the disease, so here we can see the beginnings of logical medical
thought which probably signifies a change in thinking at the time and movement away from the
heavy influence of religion and the church on medicine and medical practice.
The first method of treatment for leprosy containing the disease and isolating the patient
(Oommen, 2002:201) as the fear of contagion was strong in the Middle ages and most
8
practitioners would be aware that they did not possess the skills to cure the disease. Following
this the only treatment that was of any real help to the patient was care which was provided by
medieval hospitals. There were some who attempted to cure the disease in a variety of ways.
The more conventional and widely used treatments are discussed below but some of the more
bizarre treatments were using alchemist’s gold or earth from an anthill to purify the leper and
also apparently the blood of a turtle of the blood of an infant could also be effective (Magilton et
al, 2008:15).
Medieval medical practitioners believed that leprosy caused a dramatic imbalance of the
humours and therefore required a complex and carefully calibrated course of therapy. The
treatment options for the leper ranged from the searing pain of the lancet or cautery to the
fragrant steam of an herbal bath. Particular stress was placed on early treatment before the
disease had corrupted the vital organs (Rawcliffe, 2006:206‐7). The practitioner would generally
begin the fight against the disease by modifying the patient’s lifestyle, diet, and attempt to purge
the body of malign humours before they spread from the veins to the vital organs (Rawcliffe,
2006:212).
The recommendation of a new diet to a suspect leper would be the physician’s first step,
although it would be unlikely to make any real difference to the health of the individual it could
help to restore a degree of balance if the disease was not too far progressed and it would help
strengthen the body’s natural defences. Temperate foods such as poultry, fresh bread, eggs,
good fish, and aromatic wine were recommended as they would pass easily through the body and
cool the overheated digestive system. It has generally been believed that the leprosaria did not
offer any physical medical care to their inmates, however many of these institutions raised cattle
and hens and some allowed inmates to fish and so it seems that some leper hospitals were at
9
least able to provide a diet that accorded well with the contemporary medical advice on the
management of the disease (Rawcliffe, 2006:213‐14).
Herbal lore was also used to find remedies to help those afflicted with leprosy. Red dock,
horsemint, calamint and nettles were some of the more common plants used for treating leprosy
and other skin conditions (Rawcliffe, 2006:215). More aggressive edible treatments and ointment
concoctions were also in use. Oommen discusses the use of diaphoretics, purgatives and strong
poisons in 14th century China and also the use of mercury, copper and sulphur in 15th century
Indian treatments (2002:202) and it is possible that some desperate souls tried these more exotic
and dangerous remedies. Despite this more scientific approach to herbal remedies, they were
rarely enough to remove the disfiguring and distinct scabs caused by leprosy (Rawcliffe,
2006:218). A variety of medical ointments derived from herbs were bound by animal products
(milk, faeces, testicles, fat and blood) were also popular with all levels of the medical hierarchy of
the medieval period (Rawcliffe, 2006: 219). Although these ointments don’t survive, we find
evidence of their use in the archaeological record. In the cemetery of the leper hospital of St
Mary Magdalene, Reading, Berkshire, 2 copper‐alloy plates were found associated with a badly
necrosed and osteomyelitic right humerus from an adult female. Remains of dock leaves were
found lining the plates, suggesting the plates held some form of poultice or treatment.
Importantly dock leaves were used to treat skin conditions most of which were very similar to the
early symptoms of leprosy (Gilchrist and Sloane, 2005:103). Other medical solutions included the
use of hare blood as an ingredient in ointments and washes for serious dermatological complaints
(Rawcliffe, 2006:219).
In treating any ailment of the Middle Ages, bathing was of high importance. Bathing was
more than just a simple matter of hygiene as they were genuinely believed to be an important
part in the prevention and treatment of disease, a remnant belief from the Romans (Rawcliffe,
2006:227) which even today makes sense. In the context of leprosy, they were employed as a
10
therapeutic and palliative measure. A hot bath was designed to make the patient sweat which
would illuminate impurities through the opened pores, there was a fear that this could pose a
potential danger in letting the miasmas of disease enter the body more easily particularly during
the time of plague, but it could also let in the healing scent of medicinal herbs the fragrance of
which would strengthen and restore the spirits (Rawcliffe, 2006:227). Most forms of medical
treatment invited theological analogy and the bath with its overtones of baptism and confession
was particularly rich in religious symbolism; Medieval Christians sought to exfoliate their souls as
well as their bodies (Rawcliffe, 2006:228). Unlike other remedies, herbal baths were cheap and
simple to prepare requiring little expertise and provided considerable relief for a range of painful
symptoms (Rawcliffe, 2006:230). Once an individual was infected with leprosy it was
acknowledged that most aggressive treatments would cause more harm than good except
bathing which remained a central element of palliative care (Rawcliffe, 2006:232) and care was
the only treatment offered by the majority of hospitals.
As well as these less intrusive treatments there were of course the more extreme and
painful surgical methods in practice during the medieval period. Bloodletting was one of the
more popular surgical treatments for leprosy as well as other ailments as it was believed that
through this method the practitioner could remove some of the venomous blood and humoral
matter from the patient with relative ease (Rawcliffe, 2006:232). A similar treatment was cupping
which was more suitable for frailer patients and involved the scarification of the skin, followed by
the application of heated glass or metal vessels, the vacuum that this process creates stimulated a
gentle flow of blood which practitioner believed would draw the corrupt matter from beneath the
surface of the skin and the underlying organs (Rawcliffe, 2006:234). As a treatment this required
less expertise than bloodletting and so was perhaps a more practical and economic treatment
that could be performed in most medieval hospitals.
11
One of the least pleasant treatment methods occasionally employed was cautery. It was
developed by Islamic surgeons as a method of destroying diseased flesh, cleansing or sealing
wounds, and eliminating the vapours generated by humoral corruption (Rawcliffe, 2006:236). As
the disease progressed so did the number of applications with the belief that frequency promoted
effectiveness, cauteries could also be applied topically to deal with suppurating ulcers and in
conjunction with other forms of therapy as a means of combating the spread of poison within the
body (Rawcliffe, 2006:236). A set of 15th century drawing illustrate the fifty‐seven points for
cauterisation on a leper patient , which is far more numerous than for any other affliction
(Rawcliffe, 2006:236). Cauterisation a dangerous procedure and could inflict permanent damage,
so corrosive ointments were sometimes used as a substitute (made from caustic substances like
vitriol or arsenic) which could actually cause more harm than cautery (Rawcliffe, 2006:238).
This extensive evidence for treatments and diagnostic procedures suggests that there was
a provision of care provided for lepers and that they were not simply cast‐out from society. Their
disfigured appearance would certainly distinguish them from the rest of society and their
appearance might have provoked fear and repulsion but not to the extent where they were
forgotten about and avoided. The evidence is clear that there were many individuals striving to
help and attempt to heal lepers.
12
3. The social position of the leper
Medieval attitudes towards leprosy and its victims were varied and ambivalent and frequently
contradictory with the disease eliciting both sympathy and horror and provoking religious piety
(Magilton et al, 2008:11 and Roberts and Manchester, 2005:193). Roberts and Manchester create
an image of these liminal beings; “what a piteous spectacle on the medieval scene: poor
ostracised men, women or children, deformed, and smelling of the discharging ulcers, who were
forced to give notice of their presence with a wooden clapper and then had to beg with hoarse
voice for their material needs” (2005:199).
In the medieval period religion impacted on every aspect of life and in particular it
influenced reactions and attitudes towards the leper. Before examining the religious attitude to
leprosy it is necessary to understand Christianity in the medieval period. Purgatory was a central
theme in Christian belief in the Middle Ages and concept in the daily life of medieval citizens, as
they were taught that it was a transitional and liminal location in which the soul passed from
death to salvation. Gilchrist and Duffy describe purgatory as a place where sins were purged by
every kind of physical torment, before final redemption (Gilchrist, 1995:8 and Duffy, 1992:345).
Whilst Heaven and Hell were for eternity Purgatory was for an undefined period which could be
shortened (Daniell, 1997:10). In purgatory the soul would be cleansed of its sins and would then
be able to enter heaven, the alternative of course would be hell. Hell and purgatory were
depicted as being very similar except that hell was forever and descriptions of purgatory vary
between writers; English writers saw purgatory as being closer to hell whilst the Italian, Dante,
portrays it as being nearer to heaven (Daniell, 1997:11). In England it was likened to a prison of
group torture where souls would be tortured according to their sins; they might be branded, torn,
spiked, thrown into furnaces or ice‐cold water, weighed down with rocks or have their tongues
cut out (Daniell, 1997:11). The idea was that the worst imaginable things could be inflicted upon
13
a soul in purgatory so the main focus of individuals in life was to prepare for this inevitable period
of torture and try to lessen their stay in purgatory.
The belief in the eventual release of souls from purgatory was central to medieval
religion. In life people would devote energy and large sums of money to shortening the period
their souls would have to spend in purgatory (Daniell, 1997:12). People could, prior to death,
donate to religious houses and purchase new items for the churches such as chalices and in
return the priests and their congregation would include the individual in their prayers. This of
course is of disadvantage to the poor who could be forgotten and left to suffer in purgatory, but
the church would include a general prayer for all the souls in purgatory into their mass; however
this would not be as effective as having private prayers (Daniell, 1997:12). Caring for the sick and
the poor was a common charitable act performed by the wealthy to lessen their time in
purgatory, in particular the funding of hospitals (and similar institutions) and paying for the burial
of the poor, the socially insignificant, and the sick (often these would be the same individuals).
This is where the disfigured and outcast leper takes prominence.
As the doctrine of purgatory was developed there were changes in the theological
response to leprosy. Religion could look upon the leper harshly with the disease being viewed as
a symbol of “deep‐seated moral decay or as a physical manifestation of the sinfulness of the
sufferer” (Magilton, 2008:11). This view resulted in the leper being ritually cast out from the
living society and Richards describes this separation from the community where the leper was
required to kneel before the church altar under a black cloth with a black veil covering his face
while the priest read a series of prohibitions and threw earth from the cemetery over him
(1977:123‐124). This process literally declared the leper as the living dead or walking dead.
While there was the obvious revulsion at the appearance of the leper and the stench that would
emanate from the open and rancid lesions on their body, there was also a degree of sympathy for
individuals suffering from leprosy due to religious piety. The disease was seen as a physical
14
manifestation of sin and so it was a punishment believed to have been sent from God so the leper
was expected to fulfil the role of the penitent. Therefore they were also viewed as one of the
‘elect’ as it was believed that they were being allowed to endure purgatory on earth so when they
died they could pass straight to heaven. Life as a leper was not pleasant but the general
consensus was that it was preferable to endure purgatory on earth rather than the ‘real’
purgatory where “the ingenuity of the tormentors was best not imagined” (Magilton, 2008:11‐
12). Lepers who suffered with humility in life were guaranteed their salvation and providing that
they endured their punishment with appropriate “Christian fortitude” then the disease was, as
Rawcliffe put it, “a passport to paradise” (2000:241‐2). Lepers were in a sense the walking dead
but heading for salvation and so were an important source for prayers that the wealthy could
exploit in the name of Christian charity to lessen their own time in purgatory (Magilton et al,
2008:13). Those who could afford to would spend large sums of money on founding or donating
to leper hospitals which would then require the leprous inmates to pray for them. Some religious
types would go as far as kissing the sores of lepers and bathe their feet in ultimate acts of
Christian care and charity (Magilton et al, 2008:15‐16).
The leper, both feared and revered, held a distinctive position in society. They elicited
both revulsion and religious sympathy which contradicts the image of the leper as the walking
dead. We have documentary evidence that such rituals proclaiming the leper dead to the world
took place but it is important to realise that this did not mean they were ignored by the rest of
society; they simply took on a new role in society.
15
4. Analysis of Cemetery Evidence
I will now look at several cemeteries and analyse the burial information for signs of the burial
practices being influenced by disease status. This analysis will include two examples of
cemeteries with leprous occupants and two examples where there are no identified lepers. The
analysis will involve assessing whether the burial practices in use were due to disease or whether
there were more important factors that governed the choice of practice.
4.1 Hospital of St Mary Magdalene, Chichester
The site of the medieval hospital of St James and St Mary Magdalene at Chichester has a long
history. The hospital was originally built for housing lepers (specifically male lepers) and was
founded on Crown land before 1118 and being administered by the cathedral with the intention
of being the accommodation for eight of their leper brethren (Magilton et al, 2008:57 and Knusel
& Goggel, 1993:155). There is little known about the early hospital as there has been no
archaeological evidence found yet. Hospitals lack a standardised layout and vary more in size,
date, architecture, and inmates than any other type of religious house (Cullum, 1993:11) and
seem to have grown organically from smaller buildings (Magilton, 2008:57). It is likely that in its
earliest form the hospital would have been one large hall possibly with dividing screens, probably
similar to a smaller version of St Mary Spitals in London at the time of its refoundation in
1235(figure 18) (Thomas et al, 1997:27), and throughout the centuries of its use it developed and
expanded to incorporate religious use as well as medical care for an ever‐growing population.
The first mention of the hospital’s cemetery in the written record is from the very late
12th century or the very early 13th century. The skeletal material in the cemetery displays
16
evidence of leprosy (see Schultz & Roberts, 2002 for diagnosis of leprosy), tuberculosis, joint
disease, and traumatic lesions with leprous individuals occupying the earlier phase of the
cemetery in the western and middle sections, while those with traumatic lesions are found in the
eastern and more recent section which was probably in use when the hospital became an
almshouse (Knusel & Goggel, 1993:155). Leprosy became a problem in the 11th century and it is
believed that it was dying out by the 14th century (Magilton et al, 2008:9 and Lechat, 2002:161)
so on this evidence it would be expected that the earliest occupants of the hospital’s cemetery
would, predominantly, be lepers and that as the hospital became more like an alms house and
accepted people other than lepers there should be a decline in the number of leprous individuals
found in the cemetery (Magilton et al, 2008:84). This claim is supported by evidence for dates of
burial phases noted in wills; one states that the inmates are last referred to as lepers in 1418
(Magilton et al, 2008:84).
Much of the cemetery layout was influenced by several mortuary structures and it would
be fair to assume that these would be reserved for richer patrons, benefactors or perhaps even
wealthier inmates. Structure 241 (figure 5) was a shallow, rectangular pit with the remains of an
insubstantial wall foundation on the North side and a strip of gravel on the South side which are
thought to be the remains of the counterpart to the North wall foundation thus creating a
complete wall surrounding the feature (Magilton et al, 2008:86). Central to this structure was
skeleton 88,
Figure 5: Tomb 241 with
skeletons 115, 88, and
55. (Magilton et al,
2008:87).
17
a young to middle aged with lepromatous leprosy and to the south was another burial containing
skeleton 115, a mature male also with signs of leprosy. Both skeletons were intact and no direct
relationship between the two could be defined. There was a further individual (skeleton 55), a
mature male, who showed no traces of leprosy or any other disease, this could be the result of
misdiagnosis or this individual may indeed have had leprosy he just didn’t live long enough for it
too affect his bones. There were two other similar structures in the cemetery but neither
contained leprous individuals, structure 241 was unique in this aspect. Lepers were generally
treated as liminal members of society often being dubbed as the ‘living dead’ and being
pronounced dead to the world (Roberts and Manchester, 2005:194) but due to the unique and
fluctuating role that they held within society they were sometimes also seen as receptacles of
divine grace and were held in what could almost be considered as high regard (Fay, 2006 and
Rawcliffe, 2007). These two leprous individuals were buried in a distinctive manner which serves
the purpose of setting them apart from the other occupants of the cemetery and in this instance
it would appear that the distinction being made is not out of disrespect due to the grand nature
of the burial. I suggest that these individuals were likely to be wealthy inmates of the hospital
who also perhaps were benefactors to the establishment or relatives of benefactors. This burial
treatment suggests that it was not the disease status of the individual that governed how they
were treated after death but that social status and wealth were more important.
The majority of the cemetery is composed of single inhumations, with the exception of a
few double burials, and the dispersal pattern of the diseased can perhaps provide us with insights
into how they were treated within the community. Gender and disease have both been used to
explain the cemeteries sequence of development: the south‐west burials are almost exclusively
male and many of them displayed skeletal changes typical of leprosy, the burials in the north‐east
18
display less signs of leprosy which would concur with the general decline in prevalence of the
disease as time progressed and we also see a more regular appearance of female burials as the
hospital began to accept female inmates (Magilton et al, 2008:91). The cemetery is divided into
two areas; A and Bwhich are then subdivided into area A1, A2, B1, and B2 (figure 6). I shall begin
with area A1 which lies in the south‐west end of the cemetery. The graves in this area are
generally ordered in shoulder‐to‐shoulder columns. There were 30 skeletons in this area and at
least 18 of the individuals represented showed signs of having suffered from leprosy (figures 7, 8,
and 9). In the fourth column there were 2 leprous individuals (1 adult male, 1 young female) as
well as a mature adult male with possible syphilitic lesions which were perhapsmisdiagnosed as
leprous changes. In the sixth and final column there were six skeletons and the unusual feature
of two skeletons in one grave both of which were male and displayed signs of leprosy. Two
skeletons in one grave can often be interpreted as a sign of disrespect towards the deceased; a
way of differentiating them from the other cemetery occupants; however can we really use this
as a reason when we are discussing a hospital cemetery? It is to be expected that themajority if
not the entire cemetery population will have been ill or diseased during their life whether or not
their ailment leaves any osteological indicators. In this instance the two individuals suffered from
leprosy and I would suggest were buried in this manner perhaps due to a familial relationship or
something similar, or (and possibly a combination) due to money restraints a double burial was
more economical, and that it was not their disease status that dictated their burial. Overall there
is a high incidence of leprosy in this early phase of the cemetery with lepers being 78.5% of the
population. Magilton et al urge caution withthis interpretation and conclusion as it must be
remembered that what we can distinguish between are individuals so badly afflicted with leprosy
that the skeleton was affected and others who may have been disfigured by the disease but did
not suffer the same skeletal changes (2008:98).
19
Figure 6: Matchstick plan of all graves for which an orientation could be recorded with numbered
skeletons and with the site subdivided (Magilton et al, 2008:91).
Area A2 is reasonably organised and uses tomb 241 (discussed above) as a focus (figures
7, 8, and 9) for some of the graves which further attests to the high social status of the leprous
individuals occupying tomb 241 regardless of their disease status. This section of the cemetery
consists of three phases of burials as identified by Magilton et al (2008:99) which are the early
20
burials (figure 7) (do not cut other burials), intermediate burials (figure 8) (overly early graves but
are cut by later ones) and finally late burials (figure 9) which cut or cover others but are
themselves not cut or covered. In the early phase there are 29 identified burials, 13 of which are
described as lepers (or probable lepers) which accounts for 45% of the population in this phase of
the section suffering from leprosy (Magilton et al, 2008:99). There were 20 burials designated as
belonging to the intermediate phase with 11 displaying signs of leprosy meaning that 55% of the
population of this phase were suffering from the disease. The latest phase was concluded to have
34 burials with only 12 of thesedisplaying visible signs of leprosy (35% of the skeletons in this
phase). Within this one area we can see reasonably clear phasing evidence of the composition of
the cemetery and we can conclude that there does appear to be a reasonably high proportion of
individuals who show signs of leprosy. The percentage of leprous individuals declines slightly in
the latest phase but not to a great extent. Again it is important to remember that there may be
more individuals present who did have leprosy but that did not suffer skeletal changes. The
information from the skeletons in this area provides us with useful information about the
chronology of the cemetery and also about the prevalence of leprosy at certain stages of the
cemetery’s use.
The general distinction between area A and area B is that area B has a higher presence of
non‐adults and women, the presence of women specifically suggesting that this area is later than
area A. In area B2 there were 12 female burials and 17 male burials which were defined as
primary graves with only five of these individuals exhibiting signs of leprosy and a further
individual who showed indication of having suffered from tuberculosis. The incidence of leprosy
was 20.5% which is a substantial decline from the 35% incidence seen in the latest burials of A2.
This pattern of decline continues as there were no cases of leprosy recorded in the 11 skeletons
belonging to the intermediate phase and of the 15 individuals from the latest phase there were
only 2 individuals (females) who showed signs of leprosy and one undetermined adult who was
21
perhaps suffering from tuberculosis (Magilton, 2008:101). The evidence in this area indicates that
there was a decline in theprevalence of leprosy as time progressed which compliments the
Figure 7: The primary graves of area A. Subdivided into columns. M= certain or probable male; F=
certain or probable female;? = undetermined sex; L= leprosy; T= tuberculosis; S= syphilitic lesion
(Magilton et al, 2008:95).
22
Figure 8: The intermediate graves of area A. Subdivided into columns. M= certain or probable
male; F= certain or probable female;? = undetermined sex; L= leprosy; T= tuberculosis; S= syphilitic
lesion (Magilton et al, 2008:96).
23
Figure 9: The latest graves of area A. Subdivided into columns. M= certain or probable male; F=
certain or probable female;? = undetermined sex; L= leprosy; T= tuberculosis; S= syphilitic lesion
(Magilton et al, 2008:97).
24
evidence in area A2 suggesting the same phenomenon and this decline in area B1 appears to
follow on from A2 which arguably could mean that B1 was in use at a slightly later stage than
A2.Area B2 has the most obvious and planned layout and subdivision with clear columns and
generally even spacing between graves. This area also contains the most even spread of men,
women, and children which supports the theory that later in the hospital’s existence there was an
acceptance of mixed inmates and the facility was no longer restricted to the admission of males
only. In theprimary phase there were 17 individuals who displayed symptoms of leprosy out of a
total of 105 skeletons (16% incidence of leprous skeletons) and there were none identified in the
intermediate and latest phases. There were 116 skeletons in area B2, 17 of which displayed signs
of leprosy meaning that in this section only 15% of the skeletons were leprous (Magilton,
2008:113).
The evidence at Chichester indicates that, at least in this hospital and cemetery, it was
not disease status that necessarily dictated burial type. When we look at the distribution of the
leprous skeletons across the cemetery as a whole (figure 11) we can see the clustering of leper
burials in the south‐west area which was the area used in the early phase of the hospital when
they were supposed to only admit lepers and so this is very much expected and not an attempt to
segregatelepers from the other individuals in the cemetery. I believe that here and in most
similar institutions social and economic status were considered to be more important than
whether an individual was diseased. Diseased individuals would still be distinguished from
healthy members of society but the evidence suggests that due to religious beliefs and piety they
were pitied and aided rather than ignored and cast‐out completely.
25
Figure 10: The primary graves of area B. Subdivided into columns. M= certain or probable male;
F= certain or probable female;? = undetermined sex; L= leprosy; T= tuberculosis; S= syphilitic lesion
(Magilton et al, 2008:101).
27
4.2 St Margaret’s cemetery, Norwich.
Leprosy was one of the major health problems (amongst a variety of diseases and ailments) found
in Medieval Norwich and probably one of the most feared (Rawcliffe, 2004:305) and so is a good
area to examine the attitudes to the leper. There were several institutions in Norwich that had
their own burial grounds into which the bodies of the deceased inmates were deposited; St Giles
Hospital, Norman’s Spital (aka St Paul’s) and the leprosarium of St Mary Magdalen (figure 12)
(Fay, 2006:198). The numerous other hospitals, alms houses and leprosaria probably buried their
dead in the cemetery of the parish in which they were situated and it is these cemeteries that
have been excavated and from which we can examine the skeletal and burial evidence for the
treatment of the diseased.
The parish cemetery of St John Ber Street is estimated to have had as many as 35
individuals who suffered from leprosy residing in it during the 10th and 11th centuries (Fay,
2006:198). Skeleton 13055 was male c.16‐19 years old buried in a chalk and clay‐lined grave
which suggests that he had a distinguished personal status in life. This individual suffered from
chronic infection in the lower limbs and rhinomaxillary area of the face, indicating soft tissue
damage caused by Mycobacterium leprae (Fay, 2006:198) which would have caused observable
physiological changes but it seems that his personal reputation and wealth were considered more
important than his status as a diseased individual.
The most extensively excavated parish cemetery of Medieval Norwich is St Margaret’s
located in the Fyebridge area which housed a higher head count of chronic sick than in any of the
neighbouring wards (Pound, 1971:68‐93). Fay remarks on the cemetery as being “remarkable not
only for the startling catalogue of human suffering evident in its human remains, but also for the
range of burial customs found there” (2006:198). The medical conditions seen in the skeletons
inform us of the personal history of each individual by implying the pain, disfigurement, and
disability that they suffered and also the poor living conditions that they endured (Stirland, 1997).
29
At this cemetery we see a variety of responses to the dead with regards to their social position in
life whether this be influenced by economy or disease. The church and the cemetery were in use
from about AD 1200 to 1468 and were situated just inside the town wall by the Northern gate and
it was just outside this gate that there were gallows for hanging criminals (Stirland, 1997:587).
The criminals were likely to have been buried in this cemetery along with the inmates from the
hospital and the general members of the community so we can expect to see a wide range of
individuals represented. During the partial excavations in 1987, 436 articulated skeletons were
found and over 40% were in graves of multiple occupancy; ranging from 2 to 12 individuals, a
feature which makes the cemetery quite unique (Fay, 2006:198, Stirland, 1997:587).
Many of the burials deviated from the normal Christian burial practice in alignment and
body position (Roberts, 2009:50). Grave 480 (figure 13) demonstrates this; it held 4 bodies with
one being deposited in a prone position, 3 on a North‐South alignment and one South‐North.
Group burials are not necessarily a sign of disrespect towards the dead or a method of
distinguishing them. In many instances it seems that they are more a way of conserving
expenditure of money and labour (Fay, 2006:199). The best evidence for the use of mass graves
in the medieval period is from the plague pits at East Smithfield where, despite the large number
of individuals interred, order amongst the burials and respect for the dead were maintained as
the bodies appeared to have been carefully placed in the pit (Catling, 2009:27) some were even
placed in coffins or wrapped in shrouds. Around half of the burials were in individual graves
organised into regularly spaced rows while the remaining half were in mass graves of up to five
bodies deep, but still carefully laid out and in the traditional alignment for Christian burials
(Catling, 2009:28). It is possible that the variation in burial method was due to variations in the
mortality rate rather than the social status or disease status of the individuals: in periods of high
mortality there would not be time for interment in coffins or shrouds (Hawkins, 1990). Hawkins
concluded that although the cemetery was established as a response to crisis, it was still regularly
laid out and methodically managed and organised (1990; 641). At East
30
Figure 13: Grave 480, St Margaret
Fyebridgegate (Fay, 2006:199).
Smithfield these plague pits were only introduced when the true scale of the epidemic that
London was being faced with became apparent, prior to their creation plague victims were still
being buried within churches and churchyards (Catling, 2009:27). On this evidence, I agree with
Fay’s statement that “even at a time of mass mortality…the mores of Christian practice were still
considered important” (2006:200). At St Margaret’s we see evidence of preserving order in grave
324 (figure 14) which contained 4 skeletons all laid out in the appropriate Christian manner but 2
had likely been infected by bacteria of the treponema genus (Fay, 2006:200) which supports the
view that it was not disease that dictated manner of burial. In some cases there is clear evidence
for care having been taken over depositing the body but with some deviation from the typical
Christian burial format such as some skeletons being found with evidence of clothing, meaning
31
some individuals were buried fully clothed which was unusual as normally a body would be
stripped and wrapped in a shroud (Fay, 2006:201; Gilchrist and Sloane, 2005:23).
Figure 14: Grave 324, St Margaret’s Fyebridgegate (Fay, 2006:200).
St Margaret’s cemetery provides a good body of evidence for examining the interment
patterns of leprous individuals. Six skeletons were excavated from this cemetery displaying signs
of leprosy and the burial form for each are suggestive of the interpretation that there was no
single response to lepers in medieval society (Fay, 2006:202). One of these individuals (sk.252)
was buried in a grave, judging by the proportions, intended for a single inhumation in a supine
position and with the head to the West in a standard Christian manner, however there was
another skeleton (sk.253) which was deposited just above sk.252. This secondary skeleton
displayed lesions that have been attributed to neuromuscular dystrophy, the pathology of which
prevented the corpse from being deposited in a normative position and so it was deposited prone
and crouched (Fay, 2006:202). It is possible that the grave was accidentally re‐opened which
32
would explain this strange double burial. This could also be taken as a sign of disrespect to these
diseased individuals; the second corpse could have been thrown in at the same time as the first at
the last minute because they had nowhere to put them or perhaps the grave was reopened
because the first individual was a leper and so it didn’t matter if they put another body in there to
save on space and labour. The largest group interment at the site was grave 276 (figure 15)
containing 12 individuals and the burial practice employed seems to make spiritual or social
statements about the dead (Fay, 2006:202).
Figure 15: Grave 276, St Margaret Fyebridgegate (Fay, 2006:203).
It was not wide enough to accommodate a single layer of corpses and 9 of the individuals were
buried facing down. Three of the individuals appeared to have their hands behind their backs,
which has been interpreted as them having had their hands bound and so perhaps these were
some of the criminals buried here immediately after having been hung beside the cemetery. One
skeleton displayed evidence of violent cranial trauma while another showed signs suggestive of
33
infection by Mycobacterium leprae, and a further 2 were buried with their heads to the east (Fay,
2006:202‐3). Perhaps the criminal status of some of the individuals is what influenced the burial
style in this instance and the others in the grave may also have been criminals in life and simply
did not have their hands bound when they were put in the grave. The inclusion of diseased
individuals in this grave with the supposed criminals could suggest that the diseased were
regarded with as much disdain as criminals were. Or perhaps as mentioned above this was just a
method of conserving resources and labour. This could also be a charitable burial which might
account for the variation of individuals included; a wealthier member of society paid for the burial
of these liminal characters in an attempt to raise his or her charitable status within society and
also in the hope of lessening their stay in purgatory, this view is particularly supported by the
inclusion of the leprous individual because of their unique position in society (Fay, 2006:203;
Rawcliffe, 2007:236).
Grave 153 (figure 16) is an example of the attempt by some to maintain order in the
cemetery and in the burial practices even in group interments. The burial begins in a normative
fashion where the first three skeletons were laid out with their heads to the West and in a supine
position, the next layer/other three were reversed and then the final individual appears to have
been thrown on top of the others (Fay, 2006:204). This could indicate that as the job of placing
individuals in a grave wore on, less care was taken but it could also have been because the last
individual was a late addition to the grave/and after‐thought. Whatever the reason, it is clear that
we should not quickly jump to using disdain for the diseased as a reason for deviant burial and I
suggest instead that there may well have been practical reasons behind non‐normative
interments or economic and labour restraints in place at the cemetery particularly considering the
cemetery was located in the poorest district of Norwich.
34
Figure 16: Grave 153, St Margaret Fyebridgegate (Fay, 2006: 205).
4.3 St Bartholomew’s Hospital, Bristol
When investigating the archaeological indicators of medieval attitudes towards lepers it is useful
to compare the burial rites of individuals believed to have been suffering from the disease with
burial rites of hospital inmates who show no obvious skeletal signs of disease. Such a comparison
can help ascertain whether there was a distinction made in burial practices between those
specifically suffering from leprosy and those suffering from other various ailments.
St Bartholomew’s Hospital in Bristol is believed to have been founded c.1234 by John de
la Warre II (Price & Ponsford, 1998:53). The most likely reason for him founding this hospital is
35
religious piety in the hope that such a charitable act would lessen the time his soul would spend
in purgatory. There were not a large number of burials excavated from the hospital and it
appears that there was not a large cemetery associated with it or perhaps it was simply not found
during the excavation. The burials that were excavated were located in part of building 1B (figure
17) which the excavators interpreted as having been devoted to religious use due to the burials
(Price & Ponsford, 1998:107‐8). A total of 45 burials, which also includes small groups of
miscellaneous disarticulated bone, were uncovered. These have been dated to between c.1340‐
1532. Some were reasonably complete while others consisted of only fragments but all were laid
out neatly and on the same axis as that of the building. In terms of spatial arrangement there
appears to be no particular pattern to the location of the burials except that there is a greater
concentration in the East end of the area (Price & Ponsford, 1998:117). No differentiation in
burial practice is made between sexes and both males and females are equally represented
among the sample, there is however a predominance of elderly individuals suggesting that this
was an institution aimed more at caring for the elderly rather than the sick. The pathological
evidence on the skeletons is of diseases and conditions associated with the elderly, in particular
degenerative diseases were reasonably common (Price & Ponsford, 1998:180). Seven of the
skeletons showed evidence of trauma which were all cases of healed fractures (1998:178‐9)
which suggest that medical care was being given at this institution even if it was on a basic level, it
was however unusual for there to be a physician (or the equivalent) resident at such a hospital
(Price & Ponsford, 1998:13). As previously stated there was no evidence of lepromatous leprosy
on any of the skeletons and in fact there were no identifiable bone reactions which could be
attributed to a specific infectious disease such as tuberculosis (Price & Ponsford, 1998:179).
37
Perhaps there are no examples of unusual burial practices because there were no
severely diseased individuals residing or being treated at St Bartholomew’s Hospital. The
demographic is that of elderly individuals suffering from degenerative bone diseases which would
not alter their physical appearance except from perhaps creating a limp or crouched appearance
and so they would not have been seen as ‘different’ or outcasts in society like the leper. Would a
leper or individual suffering from a more severe disease have received different burial treatment
here?
4.4 The Priory and Hospital of St Mary Spital, London
The Priory and Hospital of St Mary Spital was first founded in 1197 and then re‐founded in 1235.
The area that was excavated is located c.500m north of Bishopsgate, one of the principal gates
into the city of London, and the most important on its northern side. In 1235 Walter Brunus and
his wife Roisia issued a charter confirming the property of the priory and hospital of St Mary
Spital, for the benefit of the souls of their parents (and themselves of course) and of all dead
Christians (Thomas et al, 1997:26). St Mary Spital was one of the largest and most important
institutions providing aid for the poor and the sick in Medieval London (Thomas et al, 1997:2).
There were no lepers identified at this site but as with St Bartholomew’s it is important to
compare the burial practices of leper graves with the practices exercised on others who were
regarded as ill and as there are many illnesses that leave no skeletal traces the most likely way to
examine the graves of the sick is by examining hospital cemeteries.
The archaeological evidence for the first foundation of the priory in 1197 is limited. There
was little evidence of the church or hospital structures but the cemetery was excavated and so we
can still analyse this material for signs of differential burial treatments. The cemetery is located
38
to the south of the hospital area and there were two rows of graves dug along the eastern and
western edges of the area. In the eastern row 10 graves were found, 9 with human burials
aligned in the typical Christian fashion and the 10th containing only fragments of human bone
and teeth (Thomas et al 1997:23). This 10th grave was perhaps exhumed and relocated. In the
western row there were 4 evenly spaced graves all containing human remains. It is likely that
there were more graves in this row but that they were later removed during the expansion of the
priory or perhaps by more modern intervention. The position of the bodies in this row suggest
that they were buried in shrouds as their arms were found across their chests or tight to their
pelvis which indicates they were wrapped tight (Thomas et al, 1997:23). Dental evidence
suggests that there were family groupings in the cemetery although this is based on speculation
(Thomas et al, 1997:24). A mix of ages and sexes was demonstrated and there did not appear to
be any distinction in burial practice between them. This early cemetery went out of use in 1235
and it has been estimated that in that time less than 35 people would have been buried at this
location so the early phase of the hospital seemed to be a small roadside hospital housing a small
number of inmates and considering the low death rate these individuals must not have been
suffering from any serious diseases or conditions and were living here for some time, so perhaps
at this time the function of the hospital was to provide care for the poor and elderly.
There is a more substantial body of archaeological evidence for the refoundation period
of the Priory (1235‐1280) (Figure 18). The cemetery in this phase contained 9 grave rows with a
maximum of 25 graves in each row (Thomas et al, 1997:37). There were nine skeletons which
were found without trace of their graves and a further 5 were in a single large grave, it is possible
that these individuals died simultaneously of the same cause perhaps during the black death
which would mean that their being deposited in a group burial is a way of distinguishing them but
whether this was on purpose or simply due to convenience is debatable. A number of the graves
showed evidence of the use of coffins, 5 had definite evidence of coffins while others contained
39
nails and wooden pegs which suggest the presence of coffins and the bestpreserved example of
an oak
Figure 18: Plan of the principal archaeological features of St Mary Spital after the refoundation
1235‐1280 (Thomas et al, 1997:27).
coffin used at this site was C[1605] from grave C[1604] which was found in the waterlogged fill of
an older pit (1997:37‐8). All of the skeletons were laid in the usual conventional Christian
alignment; supine with the head at the west, except C[8] which was a juvenile c. 12 years old who
40
was buried with their skull and mandible placed at their feet (which were missing) (Thomas et al,
1997:38). Another exception was B[355] a neonate which was prone but according to Thomas et
al it was reasonably common for unbaptized children to be buried in such a manner (1997:38). In
total 101 skeletons were examined from this cemetery and it was concluded that there was larger
proportion of males and that 54% of the cemetery population were dead by the age of 25 and
nearly one third were dead before reaching maturity (Thomas et al, 1997:39) which immediately
suggests that the individuals from this hospital were in poor health and most likely suffering from
terminal illnesses. There was a high rate of hypoplasia in the skeletons which indicates that many
suffered from significant illnesses in childhood. The most common pathology witnessed in the
skeletal remains was vertebral defects and degenerative diseases such as osteoarthritis and there
was also evidence for healed fractures which suggests that patients were receiving some degree
of medical care at this facility (Thomas et al, 1997:40).
The Priory underwent further expansion and developments in the period 1280‐1320
when the new infirmary was built (figure 19). The most significant change was the new infirmary
being built over the previous cemetery and the new cemetery being located on the opposite end
of the priory complex (south‐east of the main priory building). The north end of the cemetery
was made up of discrete graves with limited intercutting while the south end consisted of a mass
of skeletons with little survival of the grave cuts due to the intensity of the burials (Thomas et al,
1997:63). Around a quarter of the cemetery was excavated which provided 402 skeletons for
analysis and again these individuals were presented similar health indicators as those from the
previous cemetery; evidence of hypoplasia and degenerative diseases predominating (1997:63).
The individuals from this period did however display a greater range of health problems and
diseases indicating that they were of lower health (1997:63). The presence of three individuals
suffering from diffuse idiopathic skeletalhyperostosis (DISH) is the most noteworthy feature if the
cemetery population with all 3 being male and of around 30 years if age and these burials are
grouped together forming a cluster (Thomas etal, 1997:228) which certainly acts to separate them
41
Figure 19: plan of the archaeological features of St Mary Spital, London, c1280‐1320 (Gilchrist,
1995:27)
from the other inhabitants of the cemetery. These people could have been related and were
therefore buried together or perhaps it was their disease status that granted them a
42
distinguishing burial practice and this clustering is evidence of segregating the more seriously ill
from the healthier individuals or those who were being cared for at the hospital because they
were elderly, poor, or travellers.
Throughout the phases of the priory and hospital we see evidence of the burial practices
used on the inmates. It is likely that the cemetery held not only the inmates but possibly also the
staff from the priory and hospital and so we must remember that not all the individuals buried
here were sick or poor. It is reasonable to assume that the majority of the burials would belong
to inmates and generally we see little variation of burial rites from the traditional Christian style.
There are a few cases of unusual burials but the general picture is that the diseased and sick seem
to not have received different burial rites. In comparison to leper burials I argue that there seems
to be little difference in the burial practices observed.
43
5. Discussion
There is no doubt that the image of the outcast leper has become synonymous with medieval
society but this image is not entirely accurate. Written sources indicate that while it is true that
lepers were not treated the same as everyone else, neither were they completely rejected by
society. Historic evidence about leprosy provides us with useful insights into what life was like for
the leper. We can reconstruct the physical appearance of these disfigured characters and begin
to understand the diversity in the attitudes of others to the lepers the physical attributes of
leprosy would certainly instil fear and be met with disgust but the leper’s position within society
was not this simple. We have written documentation outlining the form of ritual that might take
place (see chapter 3) during which the leper was declared dead to the world and became the
walking dead but this is not the end of the leper’s story. The evidence for the diagnosis and
treatment of leprosy indicates that care was provided for these diseased individuals (see chapter
2.2). Facilities were built on the outskirts of cities and towns to provide basic care for lepers. The
desire to care for these disfigured characters was influenced to a great extent by religious piety
and the desire to shorten the souls stay in purgatory which was achieved by performing good
Christian deeds and helping the sick was an excellent way of proving one’s Christian charity (see
chapter 3). The leper was viewed by the church as being punished by God for leading a sinful life
with the disfigurement being a physical manifestation of inner sin. This was interpreted as
suffering purgatory in this life which was preferable to the possibility of eternity in purgatory in
the afterlife. The leper was therefore viewed as a receptacle of divine grace and so to care for
them was considered to be even more beneficial to the soul resulting in the devotion of a large
amount of time and money to caring for the lepers of Medieval England.
The leper hospital of St Mary Magdalene in Chichester (see chapter 4.1) provided a large
study group of leper burials mixed with non‐leprous burials for analysis. The general dispersal of
leper graves can be explained by the phasing of the cemetery rather than being influenced by the
44
leprosy or any other diseases. There was generally a higher presence of leprous skeletons in area
A of the cemetery (figures 7, 8 and 9). In the primary phase there was a reasonably even spread
of interments including those interpreted as leprous. In the intermediate and latest phases the
graves were more concentrated in area A2 which suggests that area A1 was in use during the
earliest phase of the hospital and fell out of use later. Area A1 showed a predominance of male
burials and this combined with the documentary evidence is indicative of the hospital being built
for the admittance of male lepers. In area A2 there is also a dominance of male over female
burials concurring with the view that area A was associated with the use of the hospital as a
facility for male lepers primarily. Area B in its primary phase (figure 10) showed a more even
spread of male and female interments as well as the inclusion of non‐adults of which there were
few in area A. There was a distinct decline in the number of leprous individuals present in this
area of the cemetery in the primary phase and there were none present in the intermediate and
latest phases. In area B there was a general decline in the number of burials suggesting that this
was the section of the cemetery in use in the latest phase. It is suggested therefore that area A1
was the earliest section of the cemetery to be used and that are B as a whole was the latest part
of the cemetery in use. At St Mary Magdalene’s the dispersal pattern of leprous individuals in the
cemetery can best be explained through the phases of the hospital and cemetery’s use rather
than as a reflection of the attitudes to the diseased influencing burial practice. There were a
couple of burials where the practice witnessed differed from the norm and could perhaps inform
us of the attitude to lepers at this cemetery. These burials contained multiple occupants which
can be regarded as an indicator of disrespect and an attempt to segregate these individuals.
Burials such as these are often the result of the re‐opening of a grave which can either be because
of familial relationship where there is a desire for relatives to be buried together usually
influenced by money restraints, or it can be a sign of disrespect both to the original occupant and
the new occupant: neither are granted an individual burial. The individuals in these graves
showed signs of leprosy so this distinctive burial treatment could serve the purpose of
45
distinguishing these lepers. These are isolated examples however as the majority of the leper
burials in the cemetery are normative in style and so I conclude that these burials are indicative of
social status taking precedence over disease status. They were most likely a more viable solution
to the economic restraints of the family of the deceased and to the managers of the cemetery. In
the instance of structure 241 the practice demonstrated seems to indicate that the individuals
were of a higher status and that it was this that influenced the burial style and it certainly is not
suggestive of individuals who were repelled by society and cast‐out. It is important to remember
that this cemetery is associated with an institution specifically intended to facilitate care to
sufferers of leprosy and so it is perhaps unlikely that we would witness any strange and
differential treatment of those that would represent the majority of the population at the site.
During the later phase of the hospital it seems that it was not only lepers that were admitted and
that it became more like a care facility for the poor, elderly and sick and we don’t seem to see any
differentiation between lepers and normal occupants of the cemetery. Leprosy was perhaps in
decline at this time but we would still expect to see some level of distinction if lepers were indeed
subject to burial treatments that indicated their difference.
At St Margaret’s cemetery in Norwich (see chapter 4.2) there were a number of group
burials which provided the focus for analysis of the representation of social attitudes in burial
practices. Group burials in the past have been interpreted as a sign of disrespect to the dead and
a method of distinguishing a group but I argue that the evidence suggests that group burials were
more likely a method of conserving the expenditure of money and labour a view which is
supported by the evidence from the East Smithfield plague cemetery in London (as discussed in
chapter 4.2). In general the graves at St Margaret’s all displayed evidence of an attempt to
preserve order and to respect the deceased. The Christian burial format appears to have been
adhered to as much as possible and most of the bodies were laid out in a normative manner.
Skeletons 252 and 253 were in a double burial and it appears that this was a case of a grave being
re‐opened to include a subsequent interment similar to the burials discussed at St Mary
46
Magdalene’s (chapter 4.2 and chapter 4.1). As this cemetery was located in the impoverished
Fyebridge area of Norwich (figure 12) it is most likely that it would be required to provide burial
space for a large population and so the presence of group burials and re‐opened burials could
have been a solution to over‐crowding problems in the cemetery. A statement is still being made
about the individuals included in these graves however. Re‐opening a grave to add an individual
suggests that the original occupant and the subsequent individual are considered to be of a
relatively low social status and so it will not matter if they are compacted into the same burial.
Perhaps this burial practice indicates the low social status and wealth of the individuals and also
their families who cannot afford a separate burial. Burial practices therefore do represent social
attitudes but these are not restricted to attitudes to lepers. So far the evidence suggests that
social status and wealth were more important in deciding what burial practice was to be provided
for an individual. As discussed in chapter 3 the attitudes to lepers varied. There is a general
assumption that lepers were feared and rejected from society but the evidence suggests that
while this was true to an extent the leper was also revered in a way and perhaps this is the
attitude that is reflected in the burial evidence; the leper was not as feared as we have come to
believe and so we do not see the evidence for differentiation and segregation that we might
expect. Therefore through the analysis of the burials of lepers we can challenge the walking dead
image of the medieval leper.
Using the examples of St Bartholomew’s hospital in Bristol and the priory and hospital of
St Mary Spital in London we can see the burial practices used at hospital institutions which have
no lepers in their cemeteries. These sites serve the purpose of being control sites to which can be
compared the sites with leper burials. There appears to be no substantial difference in burial
practices which further supports the view that the medieval leper was not simply cast‐out from
society as the classic image suggests. With the exception of the group burials at St Margaret’s
cemetery in Norwich the cemetery layout at each of the sites shows no evidence of segregation
by disease or even by sex or age.
47
In conclusion the evidence from the cemeteries used in this analysis suggest that the
seeing the leper as an outcast in medieval society is an outdated image. Yes lepers were feared
and were not full members of medieval communities but this view is too simplistic to describe the
diverse role that the leper played. While they were the source of repulsion they were also God’s
elect, the chosen ones who were given the chance to endure purgatory in this life and atone for
their sins so that after their death they could proceed straight to heaven, or so it was believed in
the medieval period. This special religious significance made them recipients of Christian charity
thrust upon them by the wealthy members of society attempting to lessen their stay in purgatory
after death. There is extensive written evidence documenting the diagnostic process and
available treatments to which the leper was subjected to which tells us that these individuals
were not simply barred from society and forgotten about, they received care and in some
instances received medical treatments which were intended to cure them of their affliction.
Analysis of several English cemeteries from the medieval period provides us with evidence and
insights into the treatment of leprous individuals through burial practices. There is little evidence
to suggest that these liminal characters were treated with outright disgust and revulsion and
there does not appear to be any strong evidence that there were attempts to differentiate lepers
after death through burial form. Comparison between cemeteries with a known leper population
and cemeteries containing hospital inmates suffering from other less serious ailments indicates
that there is little difference in treatment between these groups. Any evidence of deviant burial
in the cemeteries containing lepers can be explained as a response to economic and social
factors. A number of group burials and multiple interments in one grave were witnessed and
these are most likely methods of space‐saving in the cemeteries and influenced by the wealth and
social status of the individual and their family; could they afford an individual interment. Even
within these group burials there is evidence for maintaining elements of the Christian burial
tradition and respecting the deceased. Can archaeological evidence challenge the image of the
leper as ‘the walking dead’? Yes it can to an extent. There are limitations as there are limits to
48
the archaeological visibility of leprosy and other diseases which need to remembered. This
phrase ‘the walking dead’ creates an image of an almost zombie‐like creature that is feared by
society but this is not an accurate description of the leper. Yes they were feared and separated
from society for fear of catching the disease but these individuals were cared for and certainly not
forgotten about and we can see the evidence of this reflected in their burials.
50
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