Leprosy

Unlike plague, leprosy (Hansen's disease) was often a disfiguring, lifelong disease, and it posed very different social problems. Leprosy appears to have existed in the Middle East from the early Christian Era. The earliest proof of the presence of leprosy in the Middle East has been found in the bone lesions of two skeletons from Aswân (Egypt) that date from about A.D. 500. Therefore, there can be little doubt that genuine leprosy was present from the early Islamic period and that physicians had sufficient opportunity to observe it. Practically every Arabic medical writer discussed leprosy to some degree. The pathology and therapeutics of the disease in these accounts are largely consistent with earlier Greek medical texts. The Arabic medical works said that leprosy was both contagious and hereditary; yet it was not viewed as fiercely contagious, and those sources lack any element of moral censorship of the diseased. Moreover, the medical texts did not recommend flight from lepers or their isolation from the community.

The Arabic terminology for leprosy was created on the basis of its symptomatology. Yet aside from the distinctive signs of advanced lepromatous leprosy, these terms were not restricted to leprosy and were applied to other skin disorders as well. No clinical case descriptions of leprosy have survived in the medieval Arabic medical literature that might clarify the terminology. (The best clinical description in the medieval Near East is, curiously, the early-thirteenth-century description by William, bishop of Tyre, of the condition of Baldwin IV, king of the Latin Kingdom of Jerusalem. This description contains incontrovertible evidence of the anesthetic symptoms of leprosy.) The difficulty is certainly due to the numerous forms that leprosy can take, particularly in its early stages, and its mimicry of other sKin diseases.

The Arabs in pre-Islamic Arabia were afflicted by leprosy, along with a large number of other communicable diseases. Leprosy is mentioned by the famous Arabic poets of the period. The Koran mentions in two places the healing of lepers by Jesus. More important for Muslims were the pious traditions of the Prophet concerning the disease, which were in contradiction to the medical texts. For example, the best known of these traditions is the statement that a Muslim should flee from the leper as he would flee from the lion. Similarly, another familiar tradition asserts that a healthy person should not associate with lepers for a prolonged period and should keep a spear's distance from them. The two traditions are prescriptions for social behavior and appear to deal with both moral and medical difficulties posed by the leper. The traditions may have strengthened the desire of those who wished to avoid individuals who were conspicuously afflicted by the disease because it was morally as well as physically offensive.

Atypically, leprosy was believed by some to be a punishment by God for immorality and thus was sometimes invoked as a curse for immoral behavior. But there were also traditions of the Prophet that recommended supplication to God for relief from leprosy, for the matter should not be left entirely to fate. Medically, both traditions seem to express an implicit belief in contagion, which is incompatible with the predominant Muslim view of noncontagion. The pious legend of the Prophet advising flight from the leper is, in fact, preceded by a complete denial of contagion in the canonical collection of such traditions by al-Bukhari, which was made in the ninth century. Certainly those who argued in favor of noncontagion would have been able to make a good case, because leprosy is only moderately contagious and some people are not susceptible to it at all.

The legal status of the leper was directly related to the pious traditions. Leprosy is not discussed in the Arabic legal texts as a separate subject, but it is treated as a disability within such broad areas as marriage, divorce, inheritance, guardianship, and interdiction of one's legal capacity. Because leprosy was considered a moral illness, the leper was limited in his legal rights and obligations - along with minors, the bankrupt, the insane, and slaves. In fact, the leper's status seems to have been particularly close to that of the insane in legal matters, especially with regard to marriage and divorce: A marriage could be dissolved by either person because of the disease. In Maliki law, a man in an advanced state of leprosy was to be prevented from cohabiting with his slave wives and even more so with his free wives. In addition, whereas Maliki law allowed an automatic guarantee of three days against any "faults" in a slave, that guarantee was extended to one year in the case of leprosy. Moreover, the development of the disease could be cause for his or her manumission.

The differing religiolegal traditions served as the bases for various interpretations of leprosy, and underlie a wide spectrum of behavior by and toward the leper, from total freedom of action to segregation in leprosaria. The range of popular responses to the leper is reflected in the early Arabic literature that deals with the disease and other skin irregularities. The famous Arab prose writer al-Jahiz, in the ninth century, collected poetry and narrative accounts on this subject. One of his works is devoted to physical infirmities and personal idiosyncrasies. His objective was to show that they did not hinder an individual from being a fully active member of the Muslim community or bar him from important offices. Al-Jahiz maintained that such ailments were not social stigmas but were what could be called signs of divine blessing or favor. The afflicted were spiritually compensated by God, and special merit was to be attached to their lives. He also cited numerous references to leprosy in early Arabic poetry and mentioned those poets who were themselves leprous.

Nonetheless, there are indications of discrimination against lepers. According to a late-medieval Egyptian handbook for urban market inspectors, they were not supposed to allow people suffering from leprosy to visit the baths. Lepers were also excluded from employment in endowment works. Such discrimination shows that the theological proscription of contagion might have had very little practical effect.

Leprosy certainly existed throughout the Islamic world in the medieval period, but there is no way of determining its extent. Individual cases of leprosy are occasionally mentioned in the historical literature. The most important political figure in early Islam who was afflicted by leprosy was Abd al-Aziz ibn Marwan, an early governor of Egypt who died in 704. It is reported that he suffered from "lion sickness," that is, leprosy. He was given many medications for the ailment, but they were ineffective. Therefore, his physicians advised him to move to Hulwán because of its sulfurous springs, and he built his residence there. Hot springs were a popular treatment for skin disorders in the medieval period and especially for leprosy. It is known, for example, that the Jews commonly sought healing for leprosy in the hot springs and salubrious air of Tiberias.

Shortly after the time of Abd al-Aziz, the caliph al-Walid I conferred a number of benefits on the people of Damascus, the capital, in 707. The chronicles say that "he awarded the lepers ajid said: 'Do not beg from the people.' And he awarded every invalid a servant and every blind man a leader." As he did with the invalids and the blind, the caliph apparently made provisions for the lepers. The passage seems to imply that he had the lepers separated from the rest of the population. Al-Walid's unusual act is traditionally considered by Arab historians to be the institution of the first hospital in Islam. One may well imagine that the caliph created a hospice for the afflicted in the city, comparable to Byzantine practice. The later well-known hospitals of the Ab-basid period appear to have treated lepers and those with other chronic ailments in special quarters.

Still, lepers commonly begged in the streets of the medieval cities, despite the pious endowments on their behalf and laws against mendicancy. Though many must have been genuinely leprous, it was not unusual for men and women to feign the disease by intentional disfigurement in order to receive public charity. Deception of the opposite kind was also common in the slave market, where (despite guarantees) a buyer had to be on his guard against the concealment of leprous sores on the bodies of slaves. Moreover, during the late Middle Ages, the reappearances of plague must have destroyed a large number of lepers because debility increased their vulnerability to other infections.

In the Islamic West, leprosaria were established and special quarters were designated for lepers. The quarters seem generally to have been located outside the walls of many Muslim cities, often in conjunction with leper cemeteries. In Anatolia the Ottomans built leper houses as well as hospitals. A leper asylum was built at Edirne in the time of Murad II, the first half of the fifteenth century, and functioned for almost two centuries. In 1514 the sultan Selim I established a leprosarium near Istanbul and in 1530 Sulayman II built one in Scutari, and both survived until modern times. Lepers and leprosaria were increasingly noticed by Western travelers, and their accounts add to our knowledge about the plight of the diseased. There is, however, no reliable observation of true leprosy by these travelers in the Middle East during the medieval and early modern periods, except for the report of leprosy in Egypt by Prosper Alpin in the late sixteenth century. The disease seems to have been as common in the countryside as in the cities, and leprosy, syphilis, and elephantiasis are all reported to have occurred frequently in Egyptian villages in the nineteenth century.

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