Medieval Leper Hospitals in England: An Archaeological Perspective

Abstract

LATER MEDIEVAL ENGLAND possessed over 300 documented leper hospitals, representing around a quarter of all hospital foundations, but to date a sustained discussion of this archaeological material is lacking. This paper synthesises and explores the present state of archaeological knowledge within the broader context of recent studies in other disciplines. It identifies some current issues and avenues for potential research, with particular reference to the recent archaeological work at St Mary Magdalen, Winchester, one of the most extensive excavations of a medieval leper hospital and almshouse to date.

Full text

203
© Society for Medieval Archaeology 2012 DOI: 10.1179/0076609712Z.0000000007
Medieval Archaeology, 56, 2012
Medieval Leper Hospitals in England:
An Archaeological Perspective
By SIMON ROFFEY1
LATER MEDIEVAL ENGLAND possessed over 300 documented leper hospitals, representing around
a quarter of all hospital foundations, but to date a sustained discussion of this archaeological material is
lacking. This paper synthesises and explores the present state of archaeological knowledge within the
broader context of recent studies in other disciplines. It identifies some current issues and avenues for
potential research, with particular reference to the recent archaeological work at St Mary Magdalen,
Winchester, one of the most extensive excavations of a medieval leper hospital and almshouse to date.
Despite the presence of over 300 documented leper hospitals in the medieval period,
it is surprising that comparatively little archaeological work has been conducted on them
in England in comparison to other types of religious institutions.2 Yet leper hospitals
formed an important component of the urban and social landscape of medieval Britain.
Moreover, despite important excavations having been conducted during the 1980s at
Chichester and High Wycombe, and more recently at Norwich, for example, there has
been comparatively little work that has focused on hospital buildings and no examination
of the relationship between cemetery and structural data. This is especially noticeable
when compared to comparative work conducted in France, notably at Aizier and Bayeux
(Normandy), for example.3 Furthermore, 2007 saw the publication of a multi-disciplinary
study concerning leprosaria (leper hospitals) in N France, including those at Aizier, Beauvais
and Rouen.4 We also know surprisingly little about the experience of their communities
as reflected by the material culture and even less about how people with such a
debilitating disease were provided for. Leper hospitals are therefore an area of medieval
archaeology that warrants further attention.
The aim of this study is to review and critically assess the present state of our knowl-
edge of leper hospitals from an archaeological perspective for the first time, identifying the
key issues and future research questions, with reference to ongoing excavations conducted
by the author and Dr Phil Marter at St Mary Magdalen, Winchester, Hampshire (MHARP:
Magdalen Hill Archaeological Research Project). These excavations present an unprece-
dented opportunity to investigate the material fabric of an institution dedicated to the care
of lepers, and to further our knowledge of medieval leper hospitals more generally.
In 1998, the French historian François-Olivier Touati set an agenda for the
interdisciplinary study of leprosy that would embrace archaeology as well as original
1 Department of Archaeology, Faculty of Humanities and Social Sciences, University of Winchester, Hampshire
SO22 4NR, England, UK. simon.roffey@winchester.ac.uk
2 Thomas et al 1997; Price and Ponsford 1998.
3 Jeanne 1997; Niel and Truc 2007; Niel et al 2007.
4 Tabuteau 2007.

204 simon roffey
manuscript sources.5 In contrast to the architectural and archaeological evidence, much
has now been written on the history of medieval leprosy, notably Carole Rawcliffe’s
comprehensive Leprosy in Medieval England.6 Christina Lee discusses leprosy in Anglo-Saxon
England and provides a detailed overview of the evidence from cemeteries.7 Other works
have focused, for example, on the medieval English leper in a comparative context;8
leprosy in medieval Western society;9 the leprous King Baldwin IV of Jerusalem;10 and
the Military Order of the Knights of St Lazarus.11 Otherwise leprosaria have been covered
in general historical studies of medieval hospitals;12 archaeologically as a component of
wider studies examining medieval hospitals in the context of alternate forms of monastic
and religious experience;13 and as features in the West Country landscape.14 Watson dis-
cusses the origins of medieval hospitals,15 and a very comprehensive, albeit unpublished,
study focusing on the historical evidence for individual leper hospitals in England has been
produced by Satchell.16 This work, in particular, provides a very useful framework for the
potential archaeological identification and evaluation of English leper hospitals.
Before we move on to the main discussion, some early definitions are needed, first
of what leprosy is or was perceived to be, and second of what we understand by a hospi-
tal. Leprosy, now commonly referred to as Hansen’s Disease, is a devastating disease that
can inflict extreme physical deformity and discomfort on its victims. Today, we have a
better understanding of the root causes of the disease and it is treatable. This was not the
case in the Middle Ages, however, when its appearance often engendered considerable
misunderstanding. Indeed, in the period ad 1000–1500 definitions of leprosy varied
dramatically and the disease was often a ‘catch-all’ for a wide range of skin conditions.17
Thus medieval perceptions of lepra differ considerably to our modern understanding
of Hansen’s Disease. This misunderstanding also extended to possible causes of the disease
that were beyond natural agency. On the one hand some believed leprosy was related to
sinfulness linked ultimately to sexual ‘misconduct’.18 Others proclaimed that lepers were
closer to God.19 Moreover, unlike many afflictions of the period, leprosy was a disease that
paid little heed to social class or status. Although leprosy was not just a phenomenon of
the medieval period, it appears to have been particularly prevalent at this time. The spread
of leprosy in Europe probably related to the expansion of eastern trade routes.20 DNA
studies have suggested that its origins may lie in East Africa, and thence China, with its
transmission into the Middle East and Europe coming by way of the Silk Road.21 In
western Europe, the osteoarchaeological record becomes more prolific from the 12th cen-
tury when there was a pronounced increase of leprosy in urban areas.22 Current evidence
suggests that the period ad 1050–1350 marks a particularly active phase of the disease
that made necessary the introduction of large-scale specialist and institutional care.
5 Touati 1998.
6 Rawcliffe 2006.
7 Lee 2006.
8 Richards 1977.
9 Brenner 2010a; 2010b.
10 Mitchell 2005.
11 Marcombe 2003.
12 Clay 1909; Prescott 1992; Orme and Webster 1995.
13 Gilchrist 1995.
14 Hart 1989.
15 Watson 2006.
16 Satchell 1998.
17 Including arthritic psoriasis. For an early example of this, see Zias and Mitchell 1996.
18 Cf Brody 1974.
19 Cf Touati 2000.
20 Roberts and Manchester 2005, 202.
21 Mike Taylor pers comm. See also Taylor et al 2009.
22 Roberts and Manchester 2005, 202. For a wider discussion of this, see for example Roberts 1986.

205medieval leper hospitals in england
There existed a range of hospitals in the medieval period: alongside leper hospitals
there were institutions for the acutely ill and the sick poor as well as pilgrims and travel-
lers. This research focuses on leper hospitals in particular, but does so in the context of
medieval hospitals more generally. The term ‘hospital’ is generally ascribed to religious
institutions of the post-Conquest period whose primary function was the formal care of
the ill and infirm. In reality, this rather generic term covers a range of diverse institutions
from those that focused on distinct groups, such as lepers and the terminally ill, through
to ‘hostels’ offering respite for travellers or pilgrims. Ultimately the status of such institu-
tions, as well as their relative level of formal organisation, varied. Thus one of the earliest
contemporary descriptions of a hospital, that of Lanfranc’s foundation at Harbledown,
Canterbury (Kent), records that ‘outside the western gate of the city, but further away
than were the other buildings from the north gate, on the shelving of a hill, he constructe d
wooden houses and assigned these to the use of lepers’.23 This arguably speaks more of
an enclave rather than a formal institution. Can we clearly declare this as a hospital — a
medical ‘institution’ — as is later claimed? Or rather is this an exclusive form of
communal living, or sheltered accommodation, for the diseased? Prior to Bishop Poore’s
Salisbury statute of c 1217 there appears to have been no official legislation indicating the
form or regulation of English hospitals.24 The presence of a chapel at Harbledown, and
similar pre-12th-century examples, implies both a religious context and subsequently some
semblance of rule or organisation. Religious belief inextricably linked the consequences of
sin to one’s status in life. The care of life’s disadvantaged was a central tenet to medieval
Christian practice. Thus the pious and penitential experiences offered by the framework
of institutional religion were of some relevance to those suffering from disease and
associated maladies.
It is difficult to clearly define early leper communities, such as those founded on
bishops’ manors recorded in the contemporary 13th-century Life of St Hugh.25 The
generic term ‘hospital’ may suffice, if only we perhaps understand that both its form and
function, at least prior to the later 12th century, encompassed a varying range of diverse
institutions and communities. Some hospitals were perhaps attached to religious institu-
tions and some independent; all, however, would have had a facility for the care and
welfare of their inmates as their primary basis and many perforce would have included
mechanisms for alms procurement and spiritual provision.
This paper first introduces current work at St Mary Magdalen, Winchester, before
moving on to examine the evidence for leprosy in the early medieval period as well as
argue for the possible presence of contexts for formal care in the pre-Conquest period.
In the decades following the Norman Conquest the architectural, archaeological and, in
particular, the documentary evidence for leper hospitals is much clearer, and the paper
provides an overall assessment of this material. Cemetery data has comprised the
larger part of the archaeological evidence concerning medieval leprosy and this will be
specifically addressed with reference to recent excavations.
The paper then moves on to consider the nature of leper hospital communities and
in particular the location of leprosaria. Here attention will be given to traditional historical
perceptions of lepers and their status in the medieval period, as well as issues concerning
segregation and contagion, and the potential contribution of archaeology within what has
been thus far a largely historical debate. The paper will concludes with an examination
of the form and layout of leper hospitals, with particular reference to Winchester, and
23 Eadmer in Bosanquet 1964, 16–17.
24 Watson 2006, 86.
25 Orme and Webster 1995, 41.

206 simon roffey
proposes a typology of hospital plan forms. This section ends with a consideration of the
evidence for medical care and the problems concerning the identification of medically
related artefacts from hospital excavations.
SETTING THE CONTEXT: EXCAVATIONS AT ST MARY MAGDALEN
WINCHESTER 2008–11
Excavations at St Mary Magdalen, Winchester, represent the most extensive excava-
tion of a medieval leper hospital and cemetery to date. As a consequence, the excavations
are beginning to yield important results concerning the buildings and layout of a medieval
leper hospital and its later transformation (Fig 1). Here, work has revealed a primary
phase, pre-dating the documented mid-12th-century hospital, in the form of a range of
timber buildings and linear features, including a possible cellared structure or tower,
together with a chapel and cemetery (Fig 2). This cemetery, to the north of the medieval
chapel, represents a discrete burial area, separate from the main and later cemetery to the
south. In the N cemetery, analysis indicates skeletal evidence for leprosy in the majority
of examples as well as evidence for tuberculosis, possible palliative treatment and the
burial of a pilgrim.26 These buildings and features are replaced in the mid- to late 12th
century by a rebuilt chapel with S cemetery and a parallel masonry aisled hall to the north
26 Roffey and Tucker in prep.
fig 1
St Mary Magdalen, Winchester. View of excavations in 2011 looking north-east showing full extent of
cemetery and partially excavated ‘cellar/tower’ feature. Note also pits and linear features relating to timber
structures in the north of the trench and their relationship to the cemetery. Photo: MHARP.

207medieval leper hospitals in england
(Fig 3). The substantial masonry hall appears to have been reconstructed in the late 14th
century with the addition of an attached building to its south, likely representing accom-
modation for the hospital master, and a possible building to its east (Fig 4). By the late
16th century the hospital complex had been replaced by almshouses (Fig 5). Overall work
at Winchester provides a unique opportunity for the cross-examination of cemetery and
structural data and allows for the investigation into the origins and evolution of a medieval
hospital, a subject that we shall move on to consider more widely with reference to the
early evidence.
LEPROSY AND HOSPITALS: THE PRE-CONQUEST EVIDENCE
It has been claimed that there are fewer than 20 individual examples of leprosy
from pre-Conquest England and almost half of these are from pre-Christian contexts.27
Particular early examples from Romano-British contexts may include an individual exca-
vated from Poundbury, Dorset.28 By the 14th century leper hospitals were in decline, but
27 Roberts 2002.
28 Reader 1974; but see Redfern 2005, 109 (I am grateful to Katie Tucker for drawing my attention to this
alternative interpretation).
fig 2
St Mary Magdalen, Winchester. Phase 1, pre-c 1150. The medieval cemetery shown in the centre of the
plan is framed by a series of linear features to the north, a cellared structured to the north-west and a small
masonry structure to the south-east. This may be a pre-1150 chapel. Drawing by Phil Marter, MHARP.

208 simon roffey
it is still largely unknown whether this reflected a decrease in the disease itself;29 the impact
of the Black Death; or changes within patterns of charitable patronage.30 Overall, it should
be noted that present evidence does not allow us to judge whether the disease was more
prevalent, or otherwise, by the late medieval period. The osteoarachaeological information
largely comes from sites identified as segregated places of burials, or from documented
hospitals. Equally the establishment of leprosaria may reflect a social reaction to leprosy and
not necessarily an increase in the biological disease. That said, it is noticeable that there
are only two known examples of skeletal leprosy in England post-1550, at Bristol and
London.31
Leprosy has been claimed to have been a ‘social problem’ in late Anglo-Saxon
England by at least 1044 when the leprous bishop, Ælfweard of London, was forced to
resign his bishopric.32 More generally, various sources from the Anglo-Saxon period refer
to formal provisions for the ill and infirm. At York, a church canon of the mid-8th
29 Roberts 1986; Roberts and Manchester 2005, 203.
30 Equally it is possible that diagnostic criteria of leprosy tightened from the early 14th century and admissions to
leper hospitals fell accordingly: see Demaitre 2007.
31 Roberts and Cox 2003; Walker 2009.
32 Orme and Webster 1995, 24.
fig 3
St Mary Magdalen, Winchester. Phase 2, mid- to late 12th century to late 14th century. The plan shows the
aisled infirmary, parallel and to the north of the medieval chapel. Drawing by P Marter, MHARP.

209medieval leper hospitals in england
century refers to a building where the infirm were removed to. In 796, Alcuin urged
Archbishop Eanbald II of York to ‘set up houses for the daily reception of pilgrims and
the poor’.33 At St Mary Magdalene, Partney, Lincolnshire, a hospital was set up on the
site of a middle Anglo-Saxon monastery, for the support of travellers and pilgrims some-
time before 1119. Here excavations revealed a range of structures and burials. One indi-
vidual in particular appeared to have been buried in a locked container — a mode of
burial that the authors note was an ‘Anglo-Saxon phenomenon’.34 Despite the authors’
attribution of the burial to cal ad 1080–1160, the attached radiocarbon (14C) results report
a date of cal ad 890–1050 with 86% probability. However, it is unclear as to whether the
individual in question suffered from any illness or disease beyond possible degenerative
problems. Despite Partney’s likely post-Conquest foundation, this intriguing burial may
suggest the presence of something earlier. Certainly, it would not be out of the question,
since Partney was a cell of the early medieval abbey at Bardney (Lincolnshire). Such
examples may further suggest the role of monasteries in the development of early formal
care.
33 Ibid, 17.
34 Atkins and Popescu 2010.
fig 4
St Mary Magdalen, Winchester. Phase 3, 15th to mid-16th century. The plan shows the aisled infirmary,
now with adjunct southern structure, possibly a medieval master’s lodge. Drawing by P Marter, MHARP.

210 simon roffey
Excavations in the medieval churchyard at St John’s Timberhill, Norwich, revealed
a series of burials, around a fifth of which presented evidence for leprosy.35 Radiocarbon
dates of 18 individuals showed that the burial ground came into use in cal ad 980–1030
(95% probability) and went out of use in cal ad 990–1050 (95% probability). Related
artefacts recovered from the graves were generally of a late Anglo-Saxon/Norman type.36
We cannot rule out the possibility of related hospital buildings as later burials may have
destroyed them, or they could lie under the site of the later church.
Elsewhere, excavations of the Anglo-Saxon nunnery cemetery at Nazeingby,
Northamptonshire, included evidence for osteoarthritis, hydrocephalus and a possible case
of Down’s Syndrome. Consequently, the excavator proclaimed the site as a ‘hospice run
by a religious order’.37 At St Mary Magdalen, Winchester, excavations have highlighted
the possibility of an early leper hospital on the site.38 This evidence included earthfast
fig 5
St Mary Magdalen, Winchester. Phase 4, 16th to 17th century. Institutional changes throughout its history
show the overall plan of the main hospital complex changes little from the 12th century. Drawing by P Marter,
MHARP.
35 Shepherd Popescu 2009.
36 Ibid.
37 Huggins 1978, 63. However, we should be aware that many monastic institutions would have generally had
some provision for the old and infirm.
38 Roffey and Marter 2011.

211medieval leper hospitals in england
structures and a cemetery containing a significant number of diseased individuals. A series
of linear beam-trenches, pits and postholes, some containing sherds of Saxo-Norman
pottery, represent timber structures. Many of these structures and associated burials
underlay the 12th-century masonry infirmary and chapel. To the west of the timber struc-
tures was a substantial deep ‘cellared’ or earthfast structure underneath the W end of the
medieval infirmary. This enigmatic feature is comparable to a structure at Bishopstone
(East Sussex), which the excavator interprets as the base of a timber tower, forming part
of an Anglo-Saxon high-status complex.39 Towers were certainly features of high-status,
late Anglo-Saxon settlements, such as the masonry tower (Building S18) at Portchester
Castle, Hampshire.40 The dimensions of the Bishopstone example (c 2.5 m × 3.5 m) is
similar to that at Winchester, though the latter is significantly deeper, and thus may be
more indicative of a cellar.41 It is also possible, however, that the Winchester example,
which is on a different alignment to the other timber structures, may represent a distinct
phase of early Norman secular occupation.42
The cemetery at Winchester, which also pre-dated the masonry phases, contained a
range of individuals, the majority of which had evidence for leprosy, as well as cases of
tuberculosis, hydrocephalus and malnutrition. They included men, women, children and
a neonatal burial. Significantly, 14C dates for one burial (SK9), which presented evidence
for leprosy in the form of a marked degeneration of the facial skeleton and destruction
and wasting of the foot phalanges, provided a date of cal ad 980–1160 (95% probability).
A further sample from SK 9 presented a date of cal ad 890–1040 (95% probability and
90% within ad 940–1040) with a clear spike in the area of ad 970–1030.43 This skeleton
is therefore of some significance in that it is possibly a pre-Conquest burial.44 A further
dating sample from a second burial, SK 8, however, provided a broader dateline of cal
ad 1010 to 1160 (95% probability), which may argue for a later date or some level of
continuity through the Conquest period.45 The evidence is inconclusive, however, and
though a foundation in the first few decades of the post-Conquest period is more likely,
an earlier origin cannot yet be entirely ruled out. This cemetery, together with the timber
structures, was eventually supplanted by the masonry chapel and a parallel infirmary from
the mid- or late 12th century onwards, and a new cemetery was created to the south.46
The presence of a leper hospital in pre-Conquest England may not necessarily be
unexpected, although research here is admittedly still inconclusive. The curing of lepers
features regularly in some of the hagiographic and homiletic writings of the late Anglo-
Saxon period. Ælfric’s Lives of Saints, for example, refers to St Martin healing lepers on the
road outside the gates of Paris. The leper is depicted here as an outcast, which may have
been based on Ælfric’s own experience.47 Intriguingly, Ælfric spent much of his early life
in Winchester, where he received his early monastic education. Medical treatises of the
39 Thomas 2008.
40 Cunliffe 1976; Thomas 2008, 354.
41 Roffey and Marter 2011.
42 Martin Biddle and John Hare pers comm. Here the structure may represent the primary function of the site
that was later given over to ecclesiastical usage, or, reoccupation of a pre-existing hospital that later reverted back
to its original status. In the latter case it is possible that it related to some sort of short-term occupation of the
site during the later Norman period. Alternatively, the structure may represent an ecclesiastic foundation by
Winchester’s first Norman bishop, Walkelin, to match his church of St Catherine on the Hill just 2 km to the
south-west (Derek Keene pers comm). The question of ecclesiastical function of Anglo-Saxon towers, or otherwise,
is currently the subject of PhD research by Michael Shapland: see, for example, Shapland 2008.
43 SK 9 Lab code: Wk 28630; WK 27734.
44 Roffey and Tucker in prep.
45 SK 8 Lab code: Wk 28629.
46 Current archaeological evidence suggests that the chapel existed by 1148 but was substantially remodeled in
the 1170s. For an overview of the early documentary sources, see also Biddle 1976 and Keene 1985.
47 Lee 2006, 76.

212 simon roffey
late 9th and 10th centuries, including the Old English Herbarium and the Lacnunga, allude
to a range of skin ailments, some of which may have been leprosy. More specifically, the
late 9th- or early 10th-century Bald’s Leechbook, a work with possible Winchester con-
nections, refers to the disease more directly as a ‘white roughness’ which ‘is called leprosy
in the south’.48 However, this may allude to an unspecified skin condition.49 The practice
of medicine was already widespread in England prior to the Norman Conquest and
physicians were a feature of Anglo-Saxon society from at least the 7th century.50 Alfred’s
biographer, Asser, relates, for example, that the king, who seems to have suffered from
various illnesses, was often tended by physicians (medici), possibly attached to the royal
court.51 These were likely to have been members of the clergy since the documentary
evidence from the period indicates that the ‘church took on a number of roles within the
framework of healing’.52 In this light Sally Crawford notes the life and works of St John
of Beverley (d ad 721), who was reported as effecting a number of practical, as opposed
to miraculous, cures on individuals, including one with a serious skin condition.53 At
Winchester, for example, remedies of a miraculous nature were ascribed to the tomb and
shrine of St Swithun. These cures, according to his biographer Ælfric, were too numerous
to record, and people would travel from many miles to visit, including as far as Rome.54
The mid-10th century presented widespread changes in the nature of institutional
religion itself. From the 950s, Bishop Æthelwold of Winchester introduced a programme
of national reform. These reforms, codified by the Regularis Concordia, were ultimately based
on the continental Rule of St Benedict. Writing in the 6th century, Benedict ordered his
monks to set aside places for the care of sick brethren as well as the appointment of a
warden to look after them.55 In fact no other Rule brings together ‘such a complete
program of treatment for the sick’.56 The English reforms also led to the tighter regulation
of religious life and included the enclosure of monastic spaces.57 If leprosy was a concern
in later Anglo-Saxon England it is possible that such changes prompted the foundation
and enclosure of a religious community dedicated to the care of lepers, perhaps on the
outskirts of urban areas where land was more available.58 In this sense, such institutions
would have represented a more altruistic and socially orientated aspect of religious reform.
At Winchester there may also be a connection with stories relating to the charity
of Bishop Beornstan of Winchester (931–34), whose cult was fostered by Æthelwold
and later recorded by William of Malmesbury. The belief was that he had founded a
xenodochium ante portam urbis, which later in the 14th century was understood to be St John’s
Hospital in Winchester.59 The phrase could describe the location of St John’s, but might
better fit an extra-mural situation, such as St Mary Magdalen.60
Late Anglo-Saxon society certainly presented both the conditions and a socio-
religious context for the evolution of the hospital. Equally, it may have been such condi-
tions that allowed for the foundation of early Norman prototypes at places such as
48 Ibid, 75.
49 Van Ardsell 2002, 189, 197, 213–14.
50 Lee 2006, 60–1.
51 Asser in Keynes and Lapidge 1983; Pratt 2001, 70–1.
52 Crawford 2010, 45.
53 Ibid, 45.
54 Aelfric in Needham 1976, 69.
55 St Benedict, ch 36 (in Hunter Blair 1948).
56 D’Aronco, 2007, 235.
57 Rumble 2003, 25.
58 Roffey and Marter 2011.
59 Keene 1985, 81. I am grateful to Derek Keene for drawing my attention to this.
60 The earliest datable evidence for St John’s is from the early 13th century. Parts of the hospital still survive and
are incorporated in what is now known as St John’s House.

213medieval leper hospitals in england
Canterbury and possibly Winchester. A fragmentary documentary record and growing
archaeological evidence may suggest some institutional basis for the care of the infirm and
diseased, specifically from the later 10th century. If there is a case to be made for early
medieval hospitals (and here research is still in its infancy) then the central question is
whether hospitals were introduced anew by the Normans in the second half of the 11th
century, or that changing conditions after about the 1070s, such as leprosy, warranted
their foundation. Alternatively, the Normans may simply have regulated and documented
what already existed.61 Such possibilities present intriguing and important directions for
further research within the field, particularly in archaeology.
Despite tentative evidence for some form of formal and possible institutional context
for the treatment of the ill and infirm in the early medieval period, including lepers, it is
only when we come to the late 11th and early 12th century that we see the hospital emerge
as a distinct national entity. We will first provide a general assessment of the current
evidence before moving on to explore it in more specific detail.
ENGLISH LEPER HOSPITALS IN THE LATER MIDDLE AGES: AN
ASSESSMENT OF THE EVIDENCE
The majority of England’s 300 or so documented medieval leper hospitals were
founded before the 14th century.62 However, there are likely to have been many more
unrecorded, smaller and mainly rural communities that presumably left little trace in the
documentary records. Archaeologically they may also be difficult to distinguish from small
farmsteads or secular dwellings, especially as they would likely have had no chapel or
cemetery. Despite this relatively high number of foundations overall — representing
perhaps as much as a quarter of all medieval hospitals — our archaeological knowledge
of leprosaria, their buildings and their inmates, is limited. Apart from leper hospital ceme-
teries, archaeological evidence for the institutional context of medieval leprosy is rare.
There are some survivals including the chapels at Stourbridge (Cambridgeshire), Maldon
(Essex), Pamphill (Dorset) (Fig 6), Harbledown (Kent), Ripon (North Yorkshire), St Bar-
tholomew’s, Oxford,63 the chapel and infirmary at Glastonbury (Somerset) and the Lazar
House, Norwich. Partial survival of leper hospital chapels exists, among other places, at
Dunwich (Suffolk) and Gravesend (Essex). At Hillfield Gardens, Gloucester, the impressive
Romanesque doorway to the former leper hospital chapel is reused in the exterior of a
Victorian chapel, while at Winchester the original Romanesque W door of the leper hos-
pital was removed and later rebuilt into the N wall of St Peter’s church, Jewry Street. At
Blandford Forum (Dorset), the former hospital chapel is now a barn. These comparative
examples, however, represent a fractional survival and much is lost. In Normandy com-
paratively impressive examples can be found in Rouen at the chapels of St Jacques and
St Thomas at Mont-Saint-Aignan, and the chapel of St Julien at Petit-Quivery.64
One major issue concerns the survival and availability of archaeological sites. Almost
all medieval leper hospitals were founded on the boundaries of towns — areas that today
often comprise developed town suburbs where little opportunity exists for extensive
archaeological work. In the urban agricultural hinterlands, years of intensive ploughing
have taken their toll. For example, at Old Sarum, Wiltshire, archaeological evaluation
61 Nicholas Orme pers comm.
62 Satchell 1998 contains a comprehensive list.
63 This site is the focus of recent archaeological work conducted by the University of Oxford Centre for
Continuing Education. Initial excavations in 2011 have revealed evidence for masonry footings adjacent to the
14th-century chapel (David Griffiths pers comm).
64 I would like to thank Elma Brenner for reference to the Normandy examples.

214 simon roffey
conducted by Wessex Archaeology in 2002 identified the substantial, but much disturbed,
remains of the former leper hospital of St John and St Andrew. A subsequent geophysical
survey suggested that although the remains of other structures, forming part of the medi-
eval hospital, were likely to be present, their amorphous and disturbed character was
likewise consistent with the effects of deep ploughing.65
The representation of leprosaria in the documentary and archaeological records is
limited by the fact that many leper hospitals were relatively short-lived. Of the institutions
founded in England in the medieval period, less than 20 were founded after 1400.66 Many
of the earlier institutions had also been converted to more general use. In some cases
leper hospitals had ceased to function by this date, such as the hospital of St Margaret,
Huntingdon (Cambridgeshire), founded in the 12th century by King Malcolm of Scot-
land.67 At New Romney, Kent, in 1363 ‘no lepers had come . . . for a long time, and the
buildings were quite derelict’.68 At Southampton (Hampshire), the leper hospital, which
once would have been a prominent feature of the urban landscape, was largely ruinous
by 1401.69 At St Nicholas, York, the general character and number of artefacts retrieved
during excavations suggested a decline by the 15th century.70 It therefore appears that by
this period either leprosy itself was on the decrease, or that wealthy patrons generally
favoured other types of institution, such as chantries and friaries.71 Furthermore, Rawcliffe
argues that the 1279 Statute of Mortmain, which made it illegal to alienate land to the
church without a royal licence, may have proved detrimental to the foundation of leper
hospitals.72 There is also the possibility that a rise in tuberculosis, and the nature of
cross-immunity between the two diseases, led to a perceptible decline.73 A further line
of thought conjectures that, with their immunity already compromised, lepers were
65 Powell 2006.
66 Gilchrist 1995, 38.
67 Nenk et al 1994, 195.
68 Murray 1935, 198.
69 Rawcliffe 2006, 350.
70 Evans 2004.
71 See Roffey 2008 for a general discussion concerning the relationship between chantries and hospitals.
72 Rawcliffe 2006, 347.
73 Stone et al 2009, 73; also see Manchester 1991.
fig 6
Leper hospital chapel, Pamphill,
near Wimborne, Dorset. It is
likely that the western end of the
chapel also served as the
infirmary. Photograph by Simon
Roffey.

215medieval leper hospitals in england
especially susceptible to the Black Death.74 In many cases, such as Colchester (Essex),
Taunton (Somerset), Pamphill and Winchester, former leper hospitals were converted to
almshouses for the individual care of the poor and infirm. In comparison, it is likely that
Aizier, Normandy, witnessed similar institutional changes by the 15th century.75 St Mary
Magdalen, Winchester was still functioning as a leprosarium, to some extent, during the 14th
century, as it is referred to as such in Bishop Stratford’s Register of 1325.76 However,
during this period the hospital experienced financial difficulties and 11 years later we hear
that the hospital was ‘slenderley endowed’ and that its goods ‘hardly sufficed’ for the
maintenance of its community.77
These rearrangements would have often required the destruction of earlier buildings
and their replacement with structures more suitable for individual or private accommoda-
tion. These new buildings would also presumably have attracted renewed patronage as
well as clientele. This marked a transition from specialist leprosaria to general hospital.
Excavations at Winchester revealed a rebuilding programme that included parts of the
infirmary, a later ‘master’s’ lodge to its south, and other associated buildings. There was
also evidence for the partitioning of the infirmary S aisle for individual cells. Certainly,
provision was made at this time for more private forms of living, as in 1400 we hear that
‘six houses’ were present ‘besides the master’s’.78 At St Mary Magdalene, Glastonbury,
aisle cells were inserted into the main, formerly communal, infirmary hall.79 These re-
organisations and consequent transformations paralleled a wider ‘period of innovation’
witnessed by hospitals during the second half of 14th century.80 It is hard to imagine a
hospital in recession, and thus unrepresentative of what might be seen as a ‘secure invest-
ment’, attracting lay endowment otherwise. We still need caution in our interpretation of
the status of such ‘transformed’ sites, however. Thus, despite the programme of extensive
rebuilding at Winchester, a bequest by John Fromond, Steward of Winchester College
implies the presence of lepers at Winchester still in 1420: Lego ad distribuendum inter leprosos
B. Marie Magdalene, Wynton.81
A primary issue confronting the study of the material culture of medieval leprosaria
is that in some cases, particularly in earlier examples, the buildings may have been rather
rudimentary. In this light, Satchell’s comprehensive documentary survey concludes that
most leper hospitals were small, poorly funded and largely ad hoc affairs.82 Eadmer reports
that lepers at Harbledown, Canterbury, one of the first documented leper hospitals
founded in the country in 1084, lived in timber buildings clustered around the chapel.83
In Scotland at St Nicholas Farm, St Andrew’s, Fife, excavations of a timber structure may
represent the first phase of the hospital.84 Excavations at Colchester and Old Sarum, have
likewise revealed evidence for timber buildings in the hospitals primary phases,85 a factor
already noted at Winchester also. Excavations at St Giles, Brompton by the Bridge, North
Yorkshire, have indicated that the possible 12th-century infirmary hall was of timber
construction.86
74 Catling 2009, 27.
75 Niel et al 2007.
76 VCH 1973, 197.
77 Ibid, 198.
78 Ibid, 199.
79 Orme and Webster 1995, 90; Gilchrist 1995, 46.
80 Orme and Webster 1995, 127.
81 VCH 1973, 108–9.
82 Satchell 1998.
83 Clay 1909, 106.
84 Hall 1995, 52.
85 Atkins and Popescu 2010; Crossan 2004; Powell 2006.
86 Cardwell 1995.

216 simon roffey
Generally, however, it seems likely that leper hospitals were more substantial,
certainly as we move into the 12th century when timber buildings are replaced with stone.
Furthermore, the nature of the disease would have perhaps demanded considerable and
long-term accommodation and dedicated provision for the burial of the dead.
cemeteries
Despite our lack of knowledge concerning the buildings of these institutions, a little
more work has been carried out on the cemeteries, often undisturbed by later above-
ground changes. Although being a requisite demanded by the Third Lateran Council of
1179,87 evidence shows that cemeteries were not necessarily a feature of leprosaria.88 Alan
Morton has argued for the absence of a cemetery at St Mary Magdalene, Southampton,
for example, despite adequate space.89 Moreover, there have been few modern excava-
tions of leper hospital cemeteries and none in their entirety. Examples of excavated
cemeteries include Colchester, Huntingdon, High Wycombe (Buckinghamshire), Ilford,
(Essex) and South Acre (Norfolk), and in particular, the cemetery of St James and St Mary
Magdalene, Chichester (West Sussex), with its excavation of 384 skeletons from the
hospital and later almshouse.90 Overall, these studies have illustrated the wealth of patho-
logical information that can inform us about both the physical manifestations of leprosy
and the implications for those who lived and died in such institutions. Furthermore,
osteological data collected from the excavation of these cemeteries have yielded compara-
tive research examining, for example, evidence of early transmission, migration routes,
and the relationship between leprosy and tuberculosis.91
More generally, however, osteological studies have shed little light on the social
impact of leprosy in the medieval period, nor its apparent, and sudden, decline. They also
illustrate the problems concerning the identification of leprosy from human remains
in archaeological contexts. Leprosy is an infectious disease that can affect the human
skeleton.92 The clinical manifestations of the disease are variable and often dependent on
the particular resistance of the individual. Its most infectious form, Lepromatous leprosy,
can lead to significant bone damage, particularly in the nasal area and the palate (Fig 7).
In contrast, the Tuberculoid form of leprosy may present less severe bone changes.93
Ultimately, the latter may be much more difficult to identify in the archaeological
record.94 Any estimation of the impact of leprosy and the numbers of leprous dead in
individual cemeteries therefore remains difficult to ascertain accurately. Equally, it is
difficult to assess the representative level of the disease present in leprosaria at any given
time. In Denmark, excavations of the 12th-century leper hospital cemetery at Næstved
indicated rates of over 75%.95 However, at Chichester, only around 24% of the 384
individuals presented clear evidence for leprosy.96 At St John’s Timberhill, Norwich, the
87 Tanner 1990, 222–3.
88 Rawcliffe 2006, 260–2.
89 Alan Morton pers comm. Also see Birbeck and Morton forthcoming.
90 Colchester: Crossan 2004. Huntingdon: Nenk et al 1994, 194–5; Popescu and Mitchell in prep. High
Wycombe: Farley and Manchester 1989. Ilford: Gilchrist and Sloane 2005. South Acre: Wells 1967. Chichester:
Magilton et al 2008.
91 Watson et al 2009; Monot et al 2005; 2009; Taylor et al 2009; Stone et al 2009.
92 Ortner 2008, 198.
93 Roberts and Manchester 2005, 195.
94 For more detailed discussion of the affects of leprosy on the human skeleton, see, for example, Aufderhide and
Rodriguez-Martin 1998, as well as the skeletal reports from Chichester in Magilton et al 2008.
95 Richards 1977, 115–19.
96 Magilton et al 2008, 269.

217medieval leper hospitals in england
figure is 19.4%.97 At Winchester, initial analysis suggests the figure is currently closer to
85%.98
It is likely that many ‘lepers’ were wrongly diagnosed in the medieval period and we
cannot expect them to appear as ‘lepers’ in the archaeological record. Such data may also
suggest that, in some cases, lepers only formed a relatively minor, or early, representation
at so-called ‘leper hospitals’. At St Mary Magdalen, Winchester, there is skeletal evidence
of a range of other illnesses in the early phases including tuberculosis, hydrocephalous,
malnutrition and physical deformity.99 The demographic profile of the cemetery at Win-
chester is also unusual. There were a higher numbers of individuals dying in adolescence
or young adulthood than would be expected in normal attritional cemetery populations
from the pre-industrial period, perhaps suggesting a particularly high density and severity
of illness.100 Many leprosaria may have begun their life exclusively as leper hospitals; but is
also clear that many opened their doors to members of the wider community, often from
the very beginning. Hence at St Mary Magdalene, King’s Lynn (Norfolk), for example,
only three out of the 13 inmates were leprous in 1174, barely a few years after its founda-
tion.101 In some cases, this may constitute one reason for why there is a minority of lepers
in some leper hospital cemeteries.
communities
It is clear from both the documentary and archaeological evidence that there was a
wide range of people living and working in leper hospitals, each, perhaps, with different
97 Shepherd Popescu 2009.
98 As of 2012. This is by far a noticeably higher percentage than currently found in any other British examples
(Roffey and Tucker in prep will have a fuller discussion of this).
99 Roffey and Tucker in prep.
100 Ibid.
101 Orme and Webster 1995, 29.
Fig 7
Skeleton from St Mary
Magdalen, Winchester. Note
severe bone damage to the nasal
area and the palate indicative of
Lepromatous leprosy. Photograph
by S Roffey.

218 simon roffey
accommodation requirements. Generally, lepers would have lived communally, often in
large halls or infirmaries. Male and female members of a community would be segregated
through the partitioning of halls or the provision of separate dwellings, such as the paral-
lel halls found at St Mary Magdalene, Glastonbury. Some hospitals were perhaps more
specific, such as St James the Less in London, which apparently just catered for leprous
women.102 In 1333 Pope John XXII granted an annuity to the prior and chapter of
‘Winster’ to buy the church of Wonsington, of which £25 19s 4d was set aside for the
‘hospital of Mary Magdalen’. The foundation at this time, we are informed, consisted of
a priest (the master), nine poor brethren and nine poor sisters.103 Excavations on the site
have currently not found a ‘second’ infirmary. Possibly the masonry hall found on the site
had an internal division, as at Glastonbury, or a second hall lies elsewhere.
It is also possible that a form of social stratification existed within medieval hospitals,
which the arrangement of buildings reflects in certain circumstances. As noted at
Winchester, some individuals were living separately in ‘houses’ by 1400.104 Moreover it
has been claimed that where non-lepers were segregated from those that had leprosy, the
latter were demoted to less desirable accommodation.105 Even among lepers there may
have been some degree of social stratification, as at Salle-aux-Puelles, Rouen, Normandy,
where lepers eating in the great hall would pass on their scraps to lepers waiting outside.106
There would have also been some division between the inmates and administrative clergy,
in the form of separate accommodation and areas reserved for burial. For example, at
Partney, a hospital for pilgrims and travellers, excavations revealed separate burial loca-
tions for the inmates and clergy.107 At Winchester, a possible master’s house was attached
to the S aisle of the medieval infirmary. The masonry building had a central tiled hearth,
evidence for an internal partition, and may have had its own internal access to the main
infirmary.
A range of endowments supported leper hospitals: bequests of property, alms,
chantry foundation and the holding of fairs as at Winchester, where the ‘Fair Lane’ marks
the E boundary of the site.108 It is likely that in some instances wealthier inmates also had
access to their personal wealth or property rents, which may have provided them with
a comparatively higher standard of living. Sometimes inmates were required to pay on
entry, as at Lamford leper hospital in Cornwall, which permitted entry fees in 1258.109
This may suggest that financial solvency was a requirement in certain instances and
that certain hospital residents were expected to provide for themselves. At St John’s,
Heytesbury, Wiltshire, inmates were expected to provide their own pots, pans and
bedding.110 However, it should be noted that this particular hospital was functioning more
as an almshouse then a traditional communal hospital. Nonetheless it is a characteristic
that may bear comparison elsewhere.
Overall levels of support and patronage within individual leprosaria appear to have
been comparatively mixed. Although some institutions were better supported than others,
generally the evidence suggests a reasonable standard of living. At Maldon, for example,
inmates were entitled to claim ‘unsound’ bread, ale and fish only because their digestive
102 The hospital was later replaced in the 16th century by the Palace of St James. Excavations in the 1920s and
1990s revealed evidence for a 12th-century chapel on the site (see note in London Archaeologist 1995, 353).
103 British History Online 1973, 2.
104 VCH 1973, 199.
105 Ibid.
106 Brenner 2010b.
107 Atkins and Popescu 2010.
108 Keene 1985, 1123.
109 Orme and Webster 1995, 99.
110 Richards 1977, 33–4.

219medieval leper hospitals in england
systems could apparently cope with it, but they also had access to fresh food as well.111 At
St Mary Magdalene, Southampton, inmates received a penny on every tun of imported
wine, while at Winchester members of the community were provided with five pence each
a week to spend on victuals, six shillings a year on clothing, and a flitch of bacon at
major festivals.112 Medieval hospitals also had a substantial care and support staff includ-
ing lay brothers and sisters who would maintain and look after the running of the hospital,
as well as lay workers, many of whom did not necessarily live on the premises. Clerical
staff would include priests and chantry priests, clerks and the hospital master. At
Winchester, in 1342, there were two clerks and a master, William de Basynge, residing at
the hospital.113 These would all require separate accommodation that might, at the very
least, have included segregated halls or dwellings and a master’s lodge.
Thus the diversity inherent in such institutions, with different classes and social
groups, required a level of formal organisation and regulation. As with monasteries, many
hospitals conformed to a rule, albeit one the individual founders or local bishops drew up.
The rule of St Mary Magdalen, Gloucester, from the late 12th century, stipulated that
lepers had to observe the traditional disciplines of patience, obedience and charity. Here,
men and women were segregated and any transgressions of the rule were corrected at a
general meeting.114 These observances and others included in the rule suggest a comple-
mentary and formal arrangement of buildings providing for assembly rooms and an
ordered segregated layout, which may be similar to that seen in other types of hospitals
and monasteries. To modern eyes, some of the regulations may appear unusually strict.
At St Mary Magdalen, Reading (Berkshire), for example, the penalty for incontinence
was expulsion.115 In most, if not all, cases the rules of leprosaria ordained that the inmates
commit themselves to regular religious observances. Thus, at St Nicholas, Harbledown, in
1344 the lepers were to attend the chapel every morning.116 At Gloucester, everyone was
to be present at matins and to say a series of paternosters.117
In contrast to monasteries, it is likely there was no prescribed design for leper
hospitals and the form and layout of individual institutions varied. The circumstances of
each individual hospital were dependent on a number of factors including available land,
the particular social status of the inmates, levels of patronage and the intensity of the
disease itself. Clearly, the status of such institutions varied markedly. However, such
diversity was not reflected in the location of such institutions, the majority of which were
typically located on the outskirts of medieval settlements.
LOCATION: EXCLUSIVE OR EXCLUDED?
There is some evidence for the provision for lepers in monastic settings, for example,
in the 9th-century monastery of St John the Baptist in modern Israel,118 and in the 11th-
century Byzantine hospital of St John Pantokrator, Istanbul, Turkey.119 The Augustinian
priory at Maiden Bradley, Wiltshire, and the Benedictine priory at Carisbrooke, Isle
of Wight, may be comparable English examples. At Carisbrooke a leper hospital was
111 Rawcliffe 2006, 79–80.
112 VCH 1973, 199.
113 Ibid, 198.
114 Orme and Webster 1995, 69.
115 VCH 1907, 98.
116 Orme and Webster 1995, 52.
117 Ibid, 69.
118 Zias 1991.
119 Constantelos 1991.

220 simon roffey
established by St Mary’s Priory, and, although the precise location is unknown, early maps
suggest its former position at the N extreme of the priory lands.120 Recent excavations at
St John’s Timberhill, Norwich have suggested the presence of an undocumented early
cemetery for lepers on the boundary of the town.121 At Blackfriars, Ipswich (Suffolk), the
burial of a leper, likely a lay patron, was noted as ‘highly unusual’.122 In Sweden, at Lund
and Sigtuna, leper burials have been found within churchyards, where their particular
location implies that they belonged to a lower social stratum.123 Evidence for intramural
leper burial is limited, however. In the majority of cases leper hospitals were founded on
the outskirts of towns and cities.
Thus one central and important theoretical issue concerns the belief that medieval
lepers were excluded and segregated from their communities. Biblical Levite laws dealing
with ritual impurity stated that anyone with signs of lepra were to be ‘led’ or brought to
the priest.124 Consequently lepers were consigned to live ‘outside the camp’.125 Thus, it is
followed, echoes of this command resonated across Europe in laws and canons that sealed
the fate of many people infected by disease.126 Such influence may have been reflected,
for example, in Canon 23 of the 1179 Third Lateran Council, which stated that lepers
could not dwell among the healthy.127
The edict prohibiting lepers from living in towns or cities may naturally lie behind
the fact that the majority of leper hospitals were founded on the outskirts of urban areas.
The significance of these liminal locations has led Roberta Gilchrist to suggest that leper
hospitals may have marked the transitional boundary between urban civilisation and the
comparatively rural wildness of the countryside.128 Notably, this was a treatment afforded
to criminals in the late Anglo-Saxon period who were often buried on county boundar-
ies.129 In this respect, it has also been suggested that leper hospitals offered a place for the
burial of criminals, possibly as a bridge between earlier boundary burials in the Anglo-
Saxon period and later medieval churchyard burials.130 At St Giles, Brompton by the
Bridge, a single burial located on the boundary of the leper hospital, and possibly contem-
porary with the early 12th-century phase of the hospital, has been interpreted as that of
a criminal or suicide.131
Certainly, many hospitals, such as Chichester, Harbledown, Southampton and
Winchester, were located at some distance from their respective towns. Others, such as
the leper hospitals at Norwich, were located outside of the town boundaries and close to
the city entrances.132 The importance of maintaining this distinction is demonstrated at
St John’s, Thetford, Norfolk, where the hospital was suppressed in the 13th century as the
town expanded around it.133 A similar occurrence may have happened at Colchester.
Here the leper hospital chapel became the parish church and the infirmary was demol-
ished. In this case the hospital was more fortunate, as it was rebuilt to the north with a
significantly larger chapel.134
120 Waller in prep.
121 Shepherd Popescu 2009.
122 Mays 2009, 642.
123 Linderholm and Kjellström 2011.
124 Leviticus 13:2, 7, 9 and 19, in Radner 2008, 135–48.
125 Leviticus 13:46, 14:2, in Radner 2008, 135–48.
126 Demaitre 2007, 77.
127 Tanner 1990, 222–3.
128 Gilchrist 1995, 40.
129 Reynolds 2009.
130 Daniell 2002.
131 Cardwell 1995, 128.
132 Rawcliffe 2006.
133 VCH 1907, 452.
134 Crossan 2004.

221medieval leper hospitals in england
We need to exercise caution with respect to how we understand medieval percep-
tions of leprosy in both physical and spiritual terms, both as a contagious disease that
warranted formal segregation, and as a spiritual stigma linked to sin. Here it is argued
that such over-simplistic interpretations represent a ‘histographical myth’,135 and one that
owes more to Victorian scholars writing to a ‘specific biomedical and segregationist
agenda’136 than the actual experiences of medieval society.137 Historians have recently
challenged such ‘segregationist’ views, particularly with regard to medieval beliefs concern-
ing contagion.138 Here it has been argued that ‘negative attitudes towards lepers and the
danger of their proximity does not arise until the early decades of the thirteenth century’,
and even then its growth was initially slow and limited.139 Hence, many leper hospitals of
the 11th and 12th centuries served more as ‘charitable shelters for the incurable than as
isolation wards for the contagious’.140 In this light Elma Brenner, for example, explores
the social status of lepers prior to more developed notions of contagion and notes that in
12th- and 13th-century Rouen lepers were still members of civic society.141 Overall, leper
hospitals were clearly recipients of public and civic charity as well as concrete expressions
of civic and ecclesiastical responsibility.142 It is also possible that leprosaria may have been
founded to create a monastic setting in which their inmates could pursue a primarily
religious vocation.143 Thus their external perception might be one that was similarly
afforded to monastic communities.
The nature of institutionalised leprosy is clearly evident from the excavations at
St Mary Magdalen, Winchester.144 A range of substantial timber and masonry buildings,
including an infirmary and chapel, imply that both the physical and spiritual comforts of
the community were well catered for. However, it is in death that lepers seem to have
been afforded a particularly notable level of respect and dignity. The burials of the
N cemetery, many of which presented evidence for disease, in the majority of cases lep-
rosy, comprised a series of regular-cut anthropomorphic graves with carved head niches
(Fig 8). Significantly, very few of the graves intercut, suggesting that each had been marked.
The presence of a pilgrim burial in this area, also with an anthropomorphic grave and
head niche is of further note. This individual was accompanied by a scallop shell — the
traditional symbol of a pilgrimage (well established by the 11th century) to the shrine of
St James at Santiago de Compostela, Spain.145 This was clearly an individual of some
prestige, means and religious sensitivity. Overall, the evidence from the buildings and
cemetery suggests an institutional setting where the community was afforded a certain
level of care and consideration. Such a quality of life perhaps runs contrary to traditional
negative perceptions of lepers and their social circumstances.
In the main, extra-mural locations would have ideally suited leprosaria. On the town
outskirts land was often cheaper and more plentiful, allowing a degree of self-sufficiency.146
Furthermore, roadside placement facilitated the collection of alms and thus the placing of
135 Touati 2000, 180.
136 Carole Rawcliffe pers comm. See more generally Rawcliffe 2001.
137 See Clay 1909; Brody 1974.
138 Touati 1998; 2000; Demaitre 2007; Rawcliffe 2005; Brenner 2010b.
139 Conrad and Wujastyk 2000, xv.
140 Demaitre 2007, 139, 144.
141 Brenner 2010b, 139.
142 Rawcliffe 2005, 251.
143 Brenner 2010b, 142.
144 Roffey and Marter 2010a; 2010b; 2011.
145 In 1114 there was a church in Winchester dedicated to St James the Apostle (reportedly buried at Compostela);
moreover, New Minster (founded c 901) had a relic of the apostle. I am grateful to Derek Keene for this informa-
tion.
146 Magilton et al 2008, 69.

222 simon roffey
leper hospitals close to major roads was of strategic relevance. In most examples, the
leper hospital would be the first religious institution travellers and wealthy merchants
approaching a town or city saw, and therefore well placed for the collection of alms. At
Southampton, the leper hospital of St Mary Magdalene stretched for several hundred
metres along both sides of the King’s Highway to Winchester.147 In some instances, such
as at St Mary Magdalen, Reading, official procedures for the collection of roadside alms
were provided.148 Some hospitals offered guests accommodation — a useful facility where
towns closed their gates at night. Land may have also been more available for the holding
of fairs — a valuable source of income — as at Winchester and St Margaret’s, High
Wycombe.149 At Winchester, the hospital was particularly well placed, within open fields
on the border of the substantial extra-mural suburb of St Giles. It was also adjacent to the
Winchester–London road, which would have carried a significant amount of traffic.
The placing of many hospitals on major roads into towns presented potent status
symbols for their founders, often bishops, and by implication required visually impressive
and well-appointed buildings. In this sense these pious, and visible, symbols would
have effectively branded the landscape. Here leprosaria represented symbols of individual
prestige and piety. At Winchester, both the leper hospital of St Mary Magdalen and the
Hospital of St Cross (c 1137), to the south of the city, were placed on the two major
thoroughfares into the city.
It is clear that in some cases leper hospitals were a specific form of medieval institu-
tion. We might therefore expect this to be reflected in both the fabric and arrangement
of hospital buildings as well as in a particular type of material culture. Here archaeology,
in particular, can provide an important insight.
MEDIEVAL LEPER HOSPITALS: FORM, FABRIC AND MATERIAL CULTURE
The role of religion in the life of medieval leper hospitals was paramount. For prac-
tical reasons the religious life was best suited for the running, organisation and funding of
fig 8
Burial from St Mary Magdalen, Winchester. Note anthropomorphic cut with head niche and lip around the
grave edge for a lid. Photograph by S Roffey.
147 Birbeck and Morton forthcoming.
148 VCH 1907, 98.
149 Orme and Webster 1995, 93.

223medieval leper hospitals in england
hospitals, and the majority of hospitals were run along semi-monastic lines. Significantly,
as noted, religion, disease and the causes of disease were inextricably linked. This was
especially the case with leprosy. In 1179 the Third Lateran Council ordained that leper
communities should have their own independent priests. Chapels were thus common and
central features of leper houses and catered for the spiritual welfare of their communities
and, at times, members of wider society. They also provided a context for lay burial and
bequests and the foundation of chantries — all important sources of income. Despite the
rare survival of former leprosaria chapels, the surviving handful, although altered by time,
can present some indication of their former status. Extant examples together with various
illustrative sources indicate that some of these buildings were of a size comparable to most
rural parish churches (Fig 9).150 And this was a role that some of them no doubt also
served. Furthermore, many appear to have undergone little change since their original
construction, a fact indicative perhaps of the waning fortunes of many leper hospitals in
the centuries following their foundation. Despite the partial survival of some former
chapels, we know very little, in comparison, about other hospital buildings. What is clear
from the somewhat fragmentary evidence is that medieval leper hospitals, unlike regular
monasteries and other types of hospital, did not appear to conform to a standardised
or conventional plan. This, as has been seen, was largely due to their particular circum-
stances, but also based on the original requirements of their foundation.
150 Contemporary drawings and descriptions of the medieval chapel exist (see Vetusta Monumenta 3 1796 and
Wharton 1773).
fig 9
St Mary Magdalen, Winchester. Interior of chapel looking east. Note evidence for side, or chantry, chapel to
the north. Drawing by Jacob Schnebbelie (Vetusta Monumenta Vol 3, 1796).

224 simon roffey
Traditionally, it has been assumed by scholars that leper hospitals developed
organically, after the manner of the sorts of timber structures arranged around the late
11th-century chapel at Harbledown, noted by Eadmer.151 At New Romney, and St
Andrews, there is some evidence for an enclosed precinct arrangement.152 Southampton
further attests the disparate layout of some leprosaria. Here documentary analysis, backed
up with a synthesis of limited archaeological evidence, suggests that the layout of the
hospital developed organically, with an infirmary backed by a garden on one side of the
main road and a separate chapel and possible master’s house at some distance away on
the other side.153 At both Winchester and Old Sarum, ditches indicate that the hospitals
were enclosed. The ditch at Winchester likely had a palisade, suggested by the presence
of adjacent postholes. At Old Sarum there was a sequence of ditches, recut over time,
suggesting that such boundaries were regularly maintained.154 At Oxford, part of the
boundary wall may still survive encircling the medieval chapel and precinct.155
The main form of accommodation for hospital residents was the communal hall or
infirmary, as at the ‘lazar house’, Sprowston, Norwich, and St Mary Magdalene, Glaston-
bury. Unfortunately, the remnants of these particular buildings tell us very little about
internal arrangements. However, excavations on the site of St Nicholas’s hospital,
York, have revealed the remains of a 12th-century aisled hall with side aisles divided into
smaller rooms containing hearths.156 Here, indications of former compartments suggest a
level of privacy. A similar pattern exists at Winchester’s infirmary by the 14th century and
a comparable arrangement existed at the general hospital at St Mary’s Chichester. Here
the aisled hall, which still partially survives, was integral to the small and narrower chapel
to the east.
Alternative forms of hospital layout, which may potentially apply to leprosaria, include
T-shaped arrangements, as seen at St John’s Canterbury, and St Mary Spital, London,
and infirmaries integral with chapels, as at St Thomas in Canterbury, and possibly at New
Romney, Kent.157 At St Mary Magdalen, Colchester, the infirmary was adjacent to the
chapel,158 and a similar arrangement existed for St Mary Magdalen, Winchester, with the
hall running parallel to the chapel. At Aizier, two substantial masonry buildings existed to
the south and west of the chapel; the latter, on a different alignment, apparently served
as the infirmary.159 The separation of chapel and infirmary provided a courtyard between
the respective buildings that may have formed a transitional space as well as allowing
a possible claustral arrangement. They also gave the chapel a level of independence,
important perhaps in those institutions that required a clearer definition of space.
In some leprosaria the chapels themselves doubled as infirmaries, as at St James,
Dunwich, Colchester, Pamphill and the Lazar House in Norwich. Here lepers might have
been accommodated in partitioned cells, halls and galleries.160 In such circumstances there
was a clear relationship between the care of the afflicted body and spiritual provision for
the soul through proximity to the high altar. Leprosy was a particularly debilitating and
disabling disease and rule or endowment often required inmates to participate in religious
151 Clay 1909, 109.
152 Rigold 1964; Hall 1995.
153 Birbeck and Morton forthcoming.
154 Powell 2006.
155 David Griffiths pers comm.
156 Clarke 1993; Evans 2004.
157 Canterbury: Gilchrist 1995. London: Thomas et al 1997. Canterbury: Orme and Webster 1995, 91. New
Romney: Rigold 1964.
158 Crossan et al 2004.
159 Niel and Truc 2007; Niel et al 2007.
160 Gilchrist 1995, 47–8.

225medieval leper hospitals in england
ceremonies. Indeed, many poorer institutions may have relied on such endowments and
the required participation of the community. Thus the accommodation of lepers within
the chapel itself would have made such arrangements easier to facilitate.
Overall, three main types of leper hospital plan can be identified (Fig 10):161
organic, where the hospital develops irregularly without a strictly organised plan (examples
include Aizier and St Giles, Brompton by the Bridge, which may have originated as
a fairly small foundation); composite, where the chapel and infirmary are integral; and
parallel, where the chapel and infirmary are separate and aligned. Composite planning,
as at Glastonbury and Pamphill, may have been adopted for practical reasons, such
as financial or spatial restrictions, or when physical or visual access to the chapel was a
founding requirement. In parallel examples such as Winchester, New Romney and Old
Sarum, the availability of land may have offered less restriction, and the infirmaries and
chapels formed separate buildings, perhaps with a central courtyard.
Excavation can reveal how the form and fabric of medieval leper hospitals were
affected by wider social or institutional changes. At St Mary Magdalen, Winchester,
an early timber phase of occupation was replaced by a substantial parallel masonry
infirmary and chapel during the mid- to late 12th century. The hospital underwent a
programme of rebuilding and reorganisation by the end of the 14th century, including the
addition of possible clerical accommodation and further buildings. These developments
would both concur with the fragmentary documentary records for St Mary Magdalen:
they also reflect the more general pattern of decline and renewal found in other recorded
leper hospitals noted above. Significantly, the medieval plan of the hospital was still
adhered to when the masonry buildings were replaced by the brick almshouses and
master’s lodge in the later 16th century (see Fig 5). Both the almshouses themselves and
the master’s lodge partially reused the medieval foundations, and the chapel was retained
largely in its original form. This direct relationship between the medieval and post-
medieval phases suggests some level of continuity. Certainly the continuity of documen-
tary records over the period implies there was no formal institutional break. That said,
this phase did reveal some evidence for the physical impact of the Reformation and
deliberate iconoclasm. The medieval altar was stripped from its setting then broken
and reused as a threshold slab between the chapel and master’s lodge. A number of
consecration crosses were still visible on its surface.
161 This is adapted from the descriptive forms of general medieval hospital previously outlined by Gilchrist and
Sloane 2005, 33.
fig 10
Types of leper hospital layout:
1) Organic (Aizier); 2) Parallel
(Winchester after 1150); 3)
Composite (Glastonbury). Scale
is approximate guide only.
Drawing by Simon Roffey.

226 simon roffey
Despite the presence of the diseased and infirm, and the overall communal context
of the leper hospitals, it is somewhat surprising that little evidence survives for sanitation
and water management in leprosaria. It is possible that such features have been overlooked
due to a focus on cemeteries. Many systems, such as wells and latrines, would be
expected to be at some distance from these hospital buildings, like the latrine block
excavated to the north of the infirmary at St Mary Spital, London.162 In the context of
leper hospitals, part of a possible drainage system comes from Hulton Low Cross, North
Yorkshire.163 At St Mary Magdalen, Winchester, excavations revealed a sequence of
rubbish and latrine pits and possible drainage gullies to the north, and downslope, of the
hospital complex.
Due to the marginal location of leper hospitals there may have been a particular
requirement for a dedicated water supply. Springs have been identified at Harbledown,
and Launceston, Cornwall, while some hospitals may have been deliberately sited near
rivers, as at St Mary Magdalene, Totnes, Devon.164 Furthermore, there is some indication
that wells were also associated with healing, and hospitals associated with such features
are numerous, including Harbledown, Newark (Nottinghamshire), Peterborough
(Cambridgeshire) and Bath.165 At St Mary Magdalen, Winchester, the medieval well is still
a landscape feature. At Bath, the leprous King Bladud, the mythical founder of the city,
was said to have been cured by immersion in natural water.166 Water tested at sites
associated with lepers at Breewood (Staffordshire) and Burton Lazars (Leicestershire),
contains sulphur, a mineral used to alleviate skin disease.167 The importance of water in
healing and medicinal care has been noted elsewhere, such as the hospital of St John the
Baptist, Oxford, where excavations revealed the presence of possible immersion tanks at
the E end of the 13th-century infirmary.168 David Marcombe has noted that treatment
for lepers included bathing in medicinal springs and that a local tradition at Clattercote,
Oxfordshire, referred to a pool in which lepers bathed.169 As early as the 10th century,
Bald’s Leechbook refers to herbal baths, and they are likely to have differed little from
those referred to in later documents.170 Although examples are few, it is feasible that such
features may survive elsewhere and are yet to be excavated.
One serious omission from the material record of medieval leper hospitals concerns
the artefacts relating to medical care and practice. This also applies to other forms of
hospital, where little evidence for medieval medical equipment is found even on those
excavations that have produced a sizeable finds assemblage.171 A case in point is St Giles,
Brompton by the Bridge, where only a pair of tweezers from an otherwise impressive col-
lection of finds suggests any medical context.172 What many of these sites yield, however,
are objects relating to reading and writing, which might otherwise be found on monastic
sites. Such materials may represent ‘medieval provision of a kind’ in that the context
for their use and requirement might be subtly different from those found at comparative
ecclesiastical sites.173 At St Mary Magdalen, Winchester, such finds include a parchment
pricker of the 14th century and a series of small hone stones of various materials. Each
162 Thomas et al 1997, 70–1.
163 Wilson and Hurst 1967, 280.
164 Hart 1989.
165 Gilchrist 1995, 43.
166 Rawcliffe 2006, 228.
167 Satchell 1998, 146.
168 Youngs et al 1988, 270–1.
169 Marcombe 2003, 1.
170 Rawcliffe 2006, 215–16.
171 Egan 2007, 65.
172 Cardwell 1995, 190.
173 Egan 2007, 66.

227medieval leper hospitals in england
small stone was designed for wearing around the neck and would have been used presum-
ably for sharpening small tools or writing implements. Other items, from various phases
of the hospital, included spoons, scissors, knives, blades, pins and tweezers, all of which
may have had personal as well as medical functions, as well as gaming pieces and dice.
Overall, as it stands, evidence for medical artefacts from leper hospital sites appears
no different from comparative monastic sites. Whether this is due to the status of such
sites, insomuch that medical care was not conducted to any great extent, or to the current
unavailability of the evidence, cannot yet be deduced. It may be that so-called domestic
finds, such as knives and spoons, functioned in a primarily medical context — an
interpretation that may also hold for the ceramic finds.
Pottery excavated from hospital sites may provide some insight into the comparative
status of hospitals in terms of the quality of ceramics and access to imported and quality
wares. It may, furthermore, present some evidence of medicinal care and provision for
those who were disabled or infirm. The wooden vessel excavated from St Mary Spital,
London, which had a supportive flange, possibly to allow a helper to support it while
feeding a patient, may be a rare example of this.174 If this interpretation is correct, it is
likely that such objects would naturally be found on leprosaria sites. The nature of the
disease, which in some cases would limit manual dexterity, would necessitate the adaption
or introduction of particular types of domestic cookery and tableware. However, the
complication lies in the potential survival of examples: wooden objects rarely survive from
archaeological sites and ceramics are often fragmentary.
One intriguing set of ceramic objects is that recovered from one of the early burials
at St Mary Magdalen, Winchester. Here, pottery fragments were found above the left side
of the chest and above the feet of an individual: both may represent specialist artefacts
interred with the body. The presence of the ceramic objects in the context of individual
burial is comparatively unusual at this period and may represent either alms bowls,
personal food bowls, or some form of specialist utensil or medically related artefact. The
skeleton displayed evidence for severe leprosy with the loss of the majority of the maxillary
alveolar bone and the right foot with loss of bone in the metacarpals and hand phalanges.
Furthermore, the left leg appears to have been amputated at the level of the distal tibia
and fibula, and if not natural amputation as a secondary effect of leprosy, this may suggest
some level of medical and remedial attention. Apart from possible evidence for medical
care, the wider implications of this burial are that the individual must have received almost
constant assistance in life; it would hard to imagine how he coped otherwise. Similar
evidence for curative and palliative care can be found in burials at other hospital sites
including indications of poulticing or bandaging at St Mary Magdalen, Reading, Bawtry,
Lincolnshire and at St Mary Spital, London (the latter in the form of copper and alloy
plates with traces of textile).175
The paucity of evidence for medical care in hospitals may be because we are simply
not looking in the right place. In particular, hospital middens, which might often be placed
away from the main buildings, would reveal valuable information. There may even be
potential evidence for specific areas of medical and personal waste — the latter of which
may have been viewed as especially unsanitary and warranting extra precaution. In par-
ticular the whole range of documented materia medica used in the ‘treatment’ of leprosy,
some of which, such as cumin, cloves and cardamom, and various mineral preparations,
may survive reasonably well in the environmental record under the right conditions.
Contemporary documents inform us of a range of herbal and dietary palliatives for those
afflicted with leprosy. These include plants such as red dock, horsemint, calamint and
174 Ibid (fig 5.1) and fig 47 in Thomas et al 1997, 60.
175 McIntyre and Hadley 2010; Thomas et al 1997.

228 simon roffey
nettles as well as hedgehog and the blood of the hare.176 Environmental analysis from
St Giles, Brompton by the Bridge, a site that initially served as a leper hospital, indicated
that direct evidence for ‘drug plants’ was disappointingly small.177 Archaeologists have
therefore yet to conduct a systematic and targeted programme of environmental analysis
on medieval leprosaria. Pits, latrines, drains, residues, hospital gardens and floor deposits
may all contain valuable information concerning diet, medicine and hygiene. Further-
more, the analysis and quantification of faunal remains may hold clues as to the avail-
ability and type of foodstuffs as well as the use of certain animals in prescribed diets or
health programmes relating to leprosy.178
EPILOGUE: FUTURE DIRECTIONS
It is clear that the archaeological study of medieval leper hospitals offers much future
research potential. Overall, a synthesis and examination of existing historical and archae-
ological studies as presented here provides some insight into the form and fabric of
these enigmatic institutions. Some hospitals were founded no doubt as statements of piety,
others perhaps as a practical reaction to the prevalence of the disease as well as an associ-
ated public response. Current evidence suggests that, unlike monasteries of the period,
there was no regular, universal plan or predefined layout. The type and arrangement of
buildings was no doubt dependent on various factors including status, location, resources
and patronage. Moreover, documentary records and fragmentary archaeological evidence
shed little light on the origins of medieval hospitals. The existing documents date the
origin of hospitals to the late 11th century and generally it is also in this period that
leprosy is seen as being a widespread problem. Taken in this context, early hospitals such
as Winchester may date to this period, and thus may be comparable to the first docu-
mented foundation by Lanfranc at Canterbury. However, recent archaeological studies
urge caution. Such research is revealing evidence for forms of medical provision, including
that associated with leprosy, evolving prior to the Conquest, and it may be here that the
true origins of hospitals are yet to be conclusively found.
The status of the leper in medieval society is another complex issue and in recent
years some historians have questioned the tradition of social exclusion. Equally, excava-
tions at St Mary Magdalen, Winchester, have provided some comparative insight into the
material conditions experienced by lepers. In this light, further studies concerning the
material culture of leprosaria may continue to contribute to this discussion. Furthermore,
archaeological analysis, particularly excavation, will allow us to trace the long-term devel-
opment of hospitals and to identify potential evidence for diet, hygiene, sanitation and
medical treatments, which must surely have been a significant component of hospital life.
Here evidence from leper hospital cemeteries is of particular significance. However, the
evidence from excavated cemeteries thus far is fairly unrepresentative and has not allowed
for the identification of specific social groups or levels of disease occurring within particu-
lar establishments. In addition, despite information regarding the life expectancy and
general health of the community, particularly from sites such as Chichester, with the
exception of some Swedish examples, we know little about nutrition and diet.179 Questions
surrounding the social status of buried individuals and their local or regional origins are
176 Rawcliffe 2006, 215–20.
177 Cardwell 1995, 232.
178 Current work at St Mary Magdalen, Winchester includes a programme of environmental sampling and
analysis.
179 Linderholm and Kjellström 2010.

229medieval leper hospitals in england
as yet unanswered. Here the issue of whether leper hospitals, initially, were responding
to local demand or wider regional or national concerns is of prime importance in
understanding the reasons behind their increased frequency from the late 11th century.
The increasing application of DNA analysis to archaeological materials has particu-
lar significance to the study of medieval leprosy. DNA preserved in archaeological skeletal
samples drawn from leper hospital cemeteries is beginning to aid interpretations concern-
ing the wider evolutionary context and transmigration of the disease. Thus recent DNA
analyses of skeletal materials taken from leper burials have begun to shed some light on
the origins of the disease as well as the analysis of long-term changes in population struc-
ture, which may address the question of whether present-day isolates of leprosy differ from
those of medieval Europe.180 The systematic and careful excavation, and conservation,
of skeletal material drawn from hospital cemeteries, as well as clear grave-fill sampling
strategies, are of prime importance in uncovering and preserving such remains for
continued DNA analysis.
Moreover, in archaeological terms, little is understood about the interaction between
leper hospitals and the outside world, particularly concerning trade and local commerce
(such as fairs), and the provision for guests in the form of dedicated accommodation.
Likewise, the limited work on hospital sites has generally focused on the main areas of the
chapel, infirmary and especially the cemetery. Consequently, little is known about domes-
tic buildings. A whole range of ancillary buildings must have served leper hospitals. Due
to the unique nature of such institutions, these types of buildings were perhaps of some
relative importance and their study could give an indication of the level of self-sufficiency
experienced by leprosaria. However, evidence is once again lacking, with the exception of
St Andrews where excavations uncovered a possible bakehouse.181
Research on medieval leper hospitals — one of medieval Britain’s more important
and enigmatic institutions — is complex and hampered by both the fragmentary archae-
ological evidence and limited documentary sources. Recent research is but the tip of the
proverbial iceberg. Archaeological work in Britain in some ways lags behind that
conducted in France, but important excavations at urban sites such as Chichester and
Winchester are beginning to redress the balance. In particular, work at St Mary Magda-
len, Winchester, represents the first wide-scale excavations of a leprosarium, its buildings,
artefacts and cemetery. Such work has allowed for the cross-comparison of different forms
of archaeological data, as well as a wider interpretation of the social implications of
hospital foundation. As a case study, it has begun to shed some light on the development
of such institutions from inception through to transformation, reuse and eventual decline.
Research at Winchester has led to a wider assessment of the archaeological evidence for
leprosaria in medieval Britain, highlighting the specific contribution of archaeology to the
interdisciplinary agenda first outlined by Touati.
acknowledgements
First and foremost, acknowledgement is owed to my colleague and MHARP co-director
Dr Phil Marter and MHARP osteoarchaeologist, Dr Katie Tucker. Both have provided major
contributions to current interpretations concerning St Mary Magdalen, Winchester. I would also
like to thank Prof Carole Rawcliffe and Dr Elma Brenner for their comments on drafts of this
paper. Thanks also to David Ashby, Anthea Boylston, Mike Brace, Dr Paul Everill, Prof Roberta
Gilchrist, Dave Grant, Duncan and Michael Green, Dr Chris Knüsel, Alex Langlands, Dr Ryan
Lavelle, Dr Mary Lewis, Prof Nicholas Orme, Dr Mike Taylor, Dr Nick Thorpe, Kate Weikert, Dr
180 Ie Monot et al 2005; Taylor et al 2009. Sampling and a DNA analysis of the skeletal material from St Mary
Magdalen, Winchester, is currently being undertaken in collaboration with Dr Mike Taylor of the University of
Surrey.
181 Hall 1995.

230 simon roffey
Julie Wileman and Prof Barbara Yorke. Thanks also to students from the University of Winchester
who have worked and trained on the MHARP project as well as staff from the Hampshire Record
Office and Winchester Museums Service. The initial stages of the project were part-funded by the
Hampshire Field Club and Archaeological Society, the Royal Archaeological Institute and the
Society of Antiquaries London.
BIBLIOGRAPHY
Aelfric, Aelfric’s Lives of Three English Saints, ed and
trans G I Needham, Exeter: Exeter University
Press, 1976.
Asser, Alfred the Great: Asser’s Life of King Alfred and
Other Contemporary Sources, trans S Keynes and
M Lapidge, Harmondsworth: Penguin Books,
1983.
Atkins, R and Popescu, E 2010, ‘Excavations at
the Hospital of St Mary Magdalene, Partney,
Lincolnshire, 2003’, Medieval Archaeol 54,
204–70.
Aufderheide, A C and Rodriguez-Martin, C (eds)
1998, The Cambridge Encyclopaedia of Human
Paleopathology, Cambridge: Cambridge Univer-
sity Press.
Biddle, M (ed), 1976, Winchester in the Early
Middle Ages. An Edition and Discussion of the Winton
Domesday, Winchester Studies 1.
Birbeck, V and Morton, A forthcoming, ‘Archae-
ological and documentary evidence of South-
ampton’s leper house’, Hampshire Stud 67:1.
Bowers, B S (ed), 2007, The Medieval Hospital in
Medical Practice, Aldershot: Ashgate Press.
Brenner, E 2007, ‘The leper house of Mont-aux-
Malades, Rouen, in the twelfth and thirteenth
centuries’, in Tabuteau, 219–46.
Brenner, E 2010a, ‘Recent perspectives on lep-
rosy in medieval Western Europe’, Hist Compass
8:5, 388–406.
Brenner, E 2010b, ‘Outside the walls: leprosy,
exclusion, and social identity in twelfth and
thirteenth century Rouen’, in M Cohen and
J M Firnhaber-Baker (eds), Difference and Identity
in Francia and Medieval France, Aldershot:
Ashgate Press, 139–55.
British History Online <www.british-history.ac.uk/
report.aspx?compid=38118> [last accessed 24
October 2011].
Brody, S N 1974, The Disease of the Soul: Leprosy
in Medieval Literature, New York: Cornell
University.
Cardwell, P 1995, ‘Excavation of the hospital
of St Giles by Brompton Bridge, North York-
shire’, Archaeol J 152, 109–245.
Catling, C 2009, ‘The archaeology of leprosy and
the Black Death’, Current Archaeol 236, 22–9.
Clarke, A 1993, ‘Royal care for medieval lepers’,
British Archaeol News 9, 5.
Clay, R M 1909, The Medieval Hospitals of England,
London: Methuen.
Conrad, L I and Wujastyk, D (eds) 2000,
Contagion: Perspectives from Pre-Modern Societies,
Aldershot: Ashgate Press.
Constantelos, D J 1991, Byzantine Philanthropy and
Social Welfare, 2nd ed, New Rochelle, New
York: A D Caratzas.
Crossan, C 2004, ‘Excavations at St Mary Mag-
dalene’s Hospital, Brook Street, Colchester,’
Essex Archaeol and Hist 34, 91–154.
Crawford, S 2010, ‘The nadir of western medi-
cine? Texts, contexts and practice in Anglo-
Saxon England’, in S Crawford and C Lee
(eds), Bodies of Knowledge: Cultural Interpretations of
Illness and Medicine in Medieval Europe: Studies in
Early Medicine 1, Brit Archaeol Rep Int Ser
2170, 41–52.
Cunliffe, B 1976, Excavations at Portchester Castle
(Volume II: Saxon), London, The Society of
Antiquaries of London.
Daniell, C 2002, ‘Conquest, crime and theology
in the burial record 1066–1200’, in A Reynolds
and S Lucy (eds), Burial in Early Medieval England
and Wales, Society Medieval Archaeol Monogr
17, 241–55.
D’Aronco, M 2007, ‘The Benedictine rule and
care of the sick: the plan of St Gall and Anglo-
Saxon England’, in Bowers, 235–52.
Demaitre, L 2007, Leprosy in Premodern Medicine:
A Malady of the Whole Body, Baltimore: John
Hopkins University Press.
Eadmer, Eadmer’s History of Recent Events in England,
ed and trans G Bosanquet, London: Cresset
Press, 1964.
Egan, G 2007, ‘Material culture of care for the
sick: some excavated evidence from English
medieval hospitals and other sites’, in Bowers,
65–77.
Evans, D 2004, ‘Beyond the walls of York: the
road to Hull’, Archaeology of York Web Series 2,
York Archaeological Trust for Excavation and
Research <www.iadb.co.uk/dccook/discussion.php>
[accessed 15 February 2011].
Farley, M and Manchester, K 1989, ‘The ceme-
tery of the leper hospital of St Margaret, High
Wycombe, Buckinghamshire’, Medieval Archaeol
33, 82–9.

231medieval leper hospitals in england
Gilchrist, R 1995, Contemplation and Action. The
Other Monasticism, Leicester: Leicester Univer-
sity Press.
Gilchrist, R and Sloane, B 2005, Requiem. The
Medieval Monastic Cemetery in Britain, London:
Museum of London Archaeological Service.
Hall, D W 1995, ‘Archaeological excavations at
St Nicholas Farm, St Andrews, Fife, 1986–87’,
Tayside and Fife Archaeol J 1, 48–75.
Hart, J 1989, ‘Leprosy in Cornwall and Devon:
problems and perspectives’, in M Bowden,
D Mackay and P Topping (eds), From Cornwall
to Caithness, Brit Archaeol Rep Brit Ser 209,
261–9.
Huggins, P J 1978, ‘Excavations of Belgic and
Romano-British farm with middle Saxon
cemetery and churches at Nazeingbury, Essex,
1975–6’, Essex Archaeol Hist 10, 29–117.
Jeanne, D 1997, ‘Quelles problématiques pour la
mort du lépreux? Sondages archéologiques du
cimetière de Saint-Nicolas-de-la-Chesnaie à
Bayeux’, Annales de Normandie 1, 69–90.
Keene, D 1985, Survey of Medieval Winchester,
Winchester Stud 2.
Lee, C 2006, ‘Changing faces: leprosy in Anglo-
Saxon England’, in C Karkov and N Howe
(eds), Conversion and Colonization in Anglo-Saxon
England, Tempe: Arizona Center for Medieval
and Renaissance Studies, 59–81.
Linderholm, A and Kjellström, A 2011, ‘Stable
isotope analysis of a medieval skeletal sample
indicative of systemic disease from Sigtuna,
Sweden’, J Archaeol Sci 38:4, 925–33.
Magilton, J, Lee, F and Boylston, A (eds) 2008,
‘Lepers Outside the Gate’: Excavations at the Cemetery
of the Hospital of St James and St Mary Magdalene,
Chichester, 1986–87 and 1993, Counc Brit
Archaeol Res Rep 153.
Manchester, K 1991, ‘Tuberculosis and leprosy:
evidence for interaction of disease’, in Ortner
and Aufderheide, 23–35.
Marcombe, D 2003, Leper Knights: The Order of St
Lazarus of Jerusalem in England, c.1150–1544,
Woodbridge: Boydell Press.
Mays, S 2009, ‘A scapula deformity in two burials
from medieval England’, Int J Osteoarchaeol
19:5, 642–51.
McIntyre, L and Hadley, D 2010, Archaeological
Excavations at Bawtry Masonic Hall, South
Yorkshire, July 2010: the cemetery of the
medieval hospital of St Mary Magdalene
(unpubl interim report, Dept of Archaeology,
University of Sheffield).
Mitchell, P D 2005, ‘An evaluation of the leprosy
of King Baldwin IV of Jerusalem in the context
of the medieval world,’ in B Hamilton (ed),
The Leper King and His Heirs: Baldwin IV and the
Crusader Kingdom of Jerusalem, Cambridge: Cam-
bridge University Press, 245–58.
Murray, K M E 1935, ‘Excavations on the site of
the leper hospital, New Romney’, Archaeologia
Cantiana 47, 198–204.
Monot, M, Honore N, Garnier T, et al 2005, ‘On
the origin of leprosy’, Science 308, 1040–2.
Monot, M and Honore, N, Garnier T et al 2009,
‘Comparative genomic and phylogeographic
analysis of mycobacterium leprae’, Nature
Genetics 41:12, 1282–9.
Nenk, B S, Margeson, S and Hurley M 1994
‘Medieval Britain and Ireland 1993’, Medieval
Archaeology 38, 184–293.
Niel, C, Truc, M and Penna B 2007, ‘La chapelle
Saint-Thomas d’Aizier (Eure). Premiers résul-
tats de six années de fouille programmée’, in
Tabuteau, 47–109.
Niel, C and Truc, M 2007, Aizier La léproserie,
la chapelle Saint-Thomas <www.adlfi.fr/SiteAdfi/
document?base=base_notices&id=N2006-NH-0002>
[accessed 3 April 2012].
Orme, N and Webster, M 1995, The English
Hospital 1070–1570, Yale: University Press.
Ortner, D J 2008, ‘Skeletal manifestations of
leprosy’, in Magilton et al, 198–207.
Ortner, D J and Aufderheide, A C (eds) 1991,
Human Paleopathology: Current Syntheses and Future
Options, Washington D C: Smithsonian Institu-
tion Press.
Popescu, E and Mitchell, D in prep, The ceme-
tery of St Margaret’s leprosarium, Spittal’s Link,
Huntingdon.
Powell, A B 2006, ‘A possible site for the hospital
of St John the Baptist and St Anthony at Old
Sarum, Salisbury’, Wiltshire Stud 99, 213–20.
Pratt, D 2001, ‘The illnesses of king Alfred the
Great’, Anglo-Saxon England 30, 39–90.
Prescott, E 1992, The English Medieval Hospital
1050–1640, London: Seaby.
Price, R and Ponsford, M 1998, St Bartholomew’s
Hospital, Bristol. The Excavation of a Medieval
Hospital, 1976–78, Counc Brit Archaeol Res
Rep 110.
Radner, E 2008, Leviticus, Michigan: Brazos
Press.
Rawcliffe, C 2001, ‘Learning to love the leper:
aspects of institutional charity in Anglo-
Norman England’, Anglo Norman Stud 23, 231–
50.
Rawcliffe, C 2005, ‘The earthly and spiritual
topography of suburban hospitals’, in C Dyer
and K Giles (eds), Town and Country in the Middle
Ages, Soc Medieval Archaeol Monogr 22, 251–
74.
Rawcliffe, C 2006, Leprosy in Medieval England,
Woodbridge: Boydell Press.

232 simon roffey
Reader, R 1974, ‘New evidence for the antiquity
of leprosy in Early Britain’, J Archaeol Sci 1,
205–7.
Redfern, R C 2005, A gendered analysis of health
from the Iron Age to the end of the Romano-
British period in Dorset, England (mid to late
8th century bc to the end of the 4th century
ad) (unpubl DPhil thesis, University of
Birmingham).
Reynolds, A 2009, Anglo-Saxon Deviant Burial
Customs, Oxford: Oxford University Press.
Richards, P 1977, The Medieval Leper and his
Northern Heirs, New York: Barnes and Noble.
Rigold, S 1964, ‘Two Kentish hospitals re-
examined: St Mary Ospringe and SS Stephen
and Thomas, New Romney’, Archaeologia
Cantiana 79, 31–69.
Roberts, C A 1986, ‘Leprosy and leprosaria in Me-
dieval Britain’, Museum Applied Science Center for
Archaeol J 4:1, 15–21.
Roberts, C A 2002, ‘The antiquity of leprosy in
Britain: the skeletal evidence,’ in C A Roberts,
M E Lewis and K Manchester (eds), The Past
and Present of Leprosy: Archaeological, Historical,
Paleopathological, and Clinical Approaches, Brit
Archaeol Rep Int Ser 1054, 213–22.
Roberts, C A and Cox, M 2003, Health and Disease
in Britain: From Prehistory to the Present Day, Stroud:
Sutton Publishing.
Roberts, C A and Manchester, K 2005, The
Archaeology of Disease, New York: Cornell Uni-
versity Press.
Roffey, S 2008, Chantry Chapels and Medieval
Strategies for the Afterlife, Stroud: Tempus.
Roffey, S and Marter, P 2010a, ‘Recent Excava-
tions at St Mary Magdalen, Winchester’,
Medieval Archaeol 54, 404–8.
Roffey, S and Marter, P 2010b, ‘Excavations at
St Mary Magdalen, Winchester’, Monastic Res
Bulletin 16, 43–9.
Roffey, S and Marter, P 2011, ‘St Mary Magda-
len Hospital Winchester’, Brit Archaeol 177,
22–7.
Roffey, S and Tucker, K in prep, The hospital
and cemetery of St Mary Magdalen,
Winchester, in context, Int J Paleopathology.
Rumble, A, 2003, Property and Piety in Early
Medieval Winchester: Documents Relating to the
Topography of the Anglo-Saxon and Norman City and
its Minsters, Winchester Stud 4:3.
St Benedict, The Rule of St Benedict, ed and trans
D O Hunter Blair, Fort Augustus: Abbey Press,
1948.
Satchell, A E M 1998, The emergence of leper-
houses in medieval England (unpubl DPhil
thesis, University of Oxford).
Shapland, M 2008, ‘St Mary’s, Broughton,
Lincolnshire: a thegnly tower-nave in the late
Anglo-Saxon landscape’, Archaeol J 165, 471–
519.
Shepherd Popescu, E 2009, Norwich Castle: Excava-
tions and Historical Survey 1987–98, Part I: Anglo-
Saxon to c.1345, East Anglian Archaeol Rep
132.
Stone, A C, Wilbur, A K, Buikstra, J E et al 2009,
‘Tuberculosis and leprosy in Perspective’,
Yearbook of Physical Anthropol 52, 66–94.
Sweetinburgh, S 2004, The Role of the Hospital in
Medieval England: Gift Giving and the Spiritual
Economy, Dublin: Four Courts Press.
Tabuteau, B (ed) 2007, Étude des lépreux et des
léproseries au Moyen Âge dans le nord de la France.
Histoire, archéologie, patrimoine, Histoire Médiévale et
Archéologie 20.
Tanner, N P (ed and trans) 1990, Decrees of the
Ecumenical Councils 1, London: Sheed and
Ward.
Taylor, G M, Blau, S, Mays, S, et al 2009,
‘Mycobacterium leprae genotype amplified
from an archaeological case of lepromatous
leprosy in Central Asia’, J Archaeol Sci 36:10,
2408–14.
Thomas, C, Sloane, B and Phillpotts, C 1997,
Excavations at the Priory and Hospital of St Mary
Spital, London: MoLAS monogr 1.
Thomas, G 2008, ‘The symbolic lives of late
Anglo-Saxon settlements: a timber structure
and iron hoard from Bishopstone, East Sussex’,
Archaeol J 165, 334–98.
Touati, F-O 1998, Maladie et Société au Moyen Âge.
La lèpre, les Lépreux et les Léproseries dans la Province
Ecclésiastique de Sens Jusqu’au Milieu du XIVe Siècle,
Brussels: De Boeck Université.
Touati, F-O 2000, ‘Contagion and leprosy: myth,
ideas and evolution in medieval minds and
societies’, in Conrad and Wujastyk, 179–201.
Van Arsdall, A 2002, Medieval Herbal Remedies: The
Old English Herbarium and Anglo-Saxon Medicine,
New York and London: Routledge.
VCH 1906, The Victoria County History of the County
of Norfolk, Vol 2, London: HMSO.
VCH 1907, The Victoria County History of the County
of Berkshire, Vol 2, London: HMSO.
VCH 1973, The Victoria County History of the County
of Hampshire, Vol 2, London: HMSO.
Vetusta Monumenta 3 1796, London: Society of
Antiquaries.
Walker, D 2009, ‘The treatment of leprosy in
19th-century London: a case study from St
Mary Marylebone cemetery’, Int J Osteoarchaeol
19:3, 364–74.
Watson, C L, Popescu, E, Boldsen, J et al 2009,
‘Single nucleotide polymorphism analysis of

233medieval leper hospitals in england
European archaeological M.Leprae DNA’,
Public Library Science 4:10, e7547. doi:10.1371/
journal.pone.0007547.
Watson, S 2006, ‘The origins of the English
hospital’, Trans Royal Hist Soc, 6th ser, 16, 75–
94.
Wilson, D M and Hurst, D G 1967 ‘Medieval
Britain in 1966,’ Medieval Archaeol 11, 262–
319.
Wells, C 1967, ‘A leper cemetery at South Acre,
Norfolk’, Medieval Archaeol 11, 242–8.
Wharton, T 1773, The History and Antiquities of
Winchester, Winton: J Wilkes.
Youngs, S M, Clark, J, Gaimster, D R M et al
1988, ‘Medieval Britain and Ireland 1987’,
Medieval Archaeol 32, 225–314.
Zias, J 1991, ‘Leprosy and tuberculosis in the
Byzantine monasteries of the Judean Desert’,
in Ortner and Aufderheide, 197–9.
Zias, J and Mitchell, P D 1996, ‘Psoriatic arthritis
in a fifth-century Judean Desert monastery’,
American J of Physical Anthropol 101:4, 491–502.
Résumé
Maladreries au Moyen-Âge en Angle-
terre: une perspective archéologique par
Simon Roffey
Alors qu’à la fin du Moyen-Âge, l’Angleterre
comptait plus de 300 maladreries attestées par
des documents, représentant environ un quart
de tous les établissements hospitaliers, ces
matériaux archéologiques n’ont toujours pas
fait l’objet de sérieux débats. Ce papier synthé-
tise et explore l’état actuel de la connaissance
archéologique dans le contexte global d’études
récentes effectuées dans d’autres disciplines.
Il identifie certaines problématiques et pistes de
recherche potentielles, en référence notamment
aux récents travaux archéologiques de St Mary
Magdalen, Winchester, qui est à ce jour l’un
des plus grands chantiers de fouilles sur le site
d’une maladrerie et d’un asile d’indigents de
l’époque médiévale.
Zusammenfassung
Mittelalterliche Leprakrankenhäuser in
England: eine archäologische Perspe-
ktive von Simon Roffey
Im spätmittelalterlichen England gab es über
300 dokumentierte Leprakrankenhäuser, die
etwa ein Viertel aller Krankenhausgründungen
ausmachten, aber bis heute fehlt eine einge-
hende Diskussion dieses archäologischen Mate-
rials. In diesem Artikel wird der gegenwärtige
Stand der archäologischen Kenntnisse zusam-
mengefasst und im weiteren Kontext neuerer
Studien in anderen Disziplinen untersucht.
Es werden einige aktuelle Themen und Wege
für potenzielle Forschungsarbeiten identifiziert,
mit besonderem Bezug auf die neueren archäol-
ogischen Arbeiten an St Mary Magdalen,
Winchester, eine der bisher umfassendsten
Ausgrabungen eines mittelalterlichen Leprak-
rankenhauses und Armenhauses.
Riassunto
I lebbrosari medievali in Inghilterra:
una prospettiva archeologica di Simon
Roffey
Nell’Inghilterra tardomedievale esistevano oltre
300 lebbrosari documentati, ed essi rappresen-
tavano circa un quarto di tutte le istituzioni
ospedaliere, ma a tutt’oggi non si è ancora
fatta una discussione approfondita su questo
materiale archeologico. Questa relazione fa
una sintesi e una disamina dell’attuale stato di
conoscenze archeologiche nel quadro più
ampio di studi recenti in altre discipline. Iden-
tifica alcune questioni attuali e potenziali filoni
di ricerca, con particolare riferimento agli scavi
archeologici recenti di St Mary Magdalen a
Winchester, uno dei più estesi fatti finora in un
lebbrosario e ospizio di mendicità medievale.