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Cover of British Archaeology 104

Issue 104

Jan / Feb 2009



Britain’s oldest string found off Isle of Wight

Antiquities scheme saved: time to go to sea?

Consultation on ancient human remains ended Jan 31

In the press

In Brief & Phase 2


Rethinking Bush Barrow
New insights into a famous burial excavated 200 years ago

THE BIG DIG: Chichester
Burials at a leper hospital document this feared medieval disease

PEACE SITE: Greenham Common
John Schofield reports on the an archaeology of protest at the former US air base

Archaeology that matters
Gilly Carr investigates the world war two relics of the Channel Islands

on the web

Recommended websites
Caroline Wickham-Jones goes underwater and two new resources for Surrey are launched


your views and responses

CBA correspondent

Campaigns, comment and communications from the CBA
Lynne Walker and Mike Anthony give an annual pick of listed building cases


ISSN 1357-4442

Editor Mike Pitts


THE BIG DIG: Chichester

Leprosy features large in both medieval Europe and our modern imagining of those times, yet we still have much to learn about the history of this feared disease. John Magilton and Frances Lee describe the excavation of a medieval leper cemetery in West Sussex. The Hospital of St James and St Mary Magdalene, Chichester.

St James’s hospital, Chichester, was founded in the early 12th century for eight leper brethren. Excavation of part of the cemetery provides a unique opportunity to study leprosy when the disease was at its peak until its virtual eradication from the British Isles, and to examine the varied afflictions of Chichester’s sick poor from the late middle ages until the later 17th century.

Leprosy (or Hansen’s disease) is a chronic condition caused by Mycobacterium leprae. In extreme cases, the individual’s face turns blotchy and lumpy, the nose has a foul discharge and the bridge of the nose eventually collapses. It commonly leads to bone changes, particularly to the skull and limb extremities, as a result of which it can be identified in the excavated bones of infected people. The skull alterations, consisting of inflammatory changes to the oral and nasal surfaces of the nose and smoothing of the nasal orifice, are caused by infection and erosion. Indirect changes of leprous infection result from nerve damage and loss of sensation: hands and feet suffer constant minor injuries which lead to ulceration, and infection spreading to the bone.

The oldest evidence for leprosy in Europe comes from a fourth-third century BC cemetery in Italy, at Casalecchio di Reno, Bologna, where a male skeleton exhibited many of the classic signs of the disease; in Britain it has been recognised in Roman skeletons at Cirencester (Gloucestershire) and Poundbury (Dorset). There was an epidemic in western Europe between around 1100 and 1300, when several thousand leprosaria, or leper hospitals, became home for afflicted people. While it remains a health problem today in South America, Africa and Asia, for reasons not fully understood, in 14th century Europe the disease died out in all but the remotest areas.

Medieval Chichester seems to have had six hospitals, two within the old Roman walls and four leper communities outside. The identities of the latter are not all entirely clear, but the site of the hospital of St James and St Mary Magdalene, on Chichester’s eastern outskirts, was never in doubt. In the wall of a thatched cottage near Spitalfield Lane (a name first recorded in 1535), is a 19th century inscription identifying it as remnants of St James’s leper hospital, built in the reign of Henry I (1100–1135). The cemetery was located in 1947, when graves were disturbed during the construction of council houses.

The first, and larger excavation described here occurred in advance of a Chichester district council bungalow project in 1986–87. The Chichester District Archaeological Unit, directed by John Magilton, returned for further excavation in 1993, when the council sought to have a plot cleared of graves before selling it for private housing use. In a further development in 1999 a public open space was retained where the remains of hospital buildings and more graves probably lie undisturbed.

Castles, churches and monasteries have inspired a vast bibliography, but hospitals have only recently attracted the attention that they merit – and their cemeteries are even less renowned. The remains of 384 men, women and children recovered at St James’s constitute by far the largest skeletal sample from an English medieval hospital yet excavated and published. They include the first significant group of European leper remains to become available for study since work in Denmark in the 1950s. The number of intercutting graves was relatively few, so that two thirds of the skeletons are more or less complete. Given the nature of the disease, areas around hands and feet were sieved to recover the tiniest bones.

By a happy coincidence, around the time of the 1980s excavation Keith Manchester had completed a research project on leprosy and tuberculosis in Britain, and had created the Calvin Wells Laboratory for Burial Archaeology at Bradford University. The excavations provided new material excavated undermodern conditions to examine, and Frances Lee, a research student at the time, undertook the bulk of the analysis. Interim publications drew researchers to Bradford from around the world. Some of those who had studied the skeletons over the years were persuaded by Anthea Boylston, a Bradford research fellow in biological anthropology, to contribute to the publication. In particular, Donald Ortner (emeritus professor of anthropology at the Smithsonian Institution, Washington) described the appearances of leprosy in bone that are found in the Chichester skeletons. Yet the cemetery still has much to contribute to future research.

The cemetery

The excavation covered the south-eastern part of the cemetery (about half of it, if the two northern corners have been identified), which was parallel to Stane Street, the Roman road to its south linking Chichester and London. Bodies were laid with their heads to the south-west, mostly in wooden coffins in simple pits, but the shallow excavations for three tombs or mortuary houses were found in the central area. One contained the graves of two women, one of whom had eight small bronze pins around the head suggesting she may have been a nun. To the south was a rectangular pit with the remains of three men, two of whom were leprous. Overlying this was a dressed-chalk-lined tomb for a mature male. At the far north-east of the site was a charnel pit with the collected bones of at least eight individuals, including two children.

The rest, however, was a more or less regularly laid out mass of apparently unmarked individual graves. While several had been sunk through earlier burials (especially in the central zone), stratigraphy does not indicate a particular direction of cemetery growth. Neither were there many artefacts to help date graves. There was, however, strong spatial variation in grave contents across the excavated area. This could reflect functional use (lepers mostly buried to the west, for example). The alternative and preferred interpretation is that this pattern is the outcome of changing times.

The original hospital occupants would be expected to be mostly male, and many of them lepers. By the 15th century the hospital had become, in effect, an almshouse, and while occupants were still mostly male, there were fewer lepers; the last reference to one was in 1418. By 1600 both sexes were approximately equally represented. The hospital survived the Dissolution (1536–41), but in 1705 the buildings were “ruinous”.

It is possible to see this development in the graves: as the institution changed from a principally male leper community, to an almshouse mostly for men who were not leprosy sufferers, that finally became a general hospital for the needy, the cemetery grew from the west. Ceramic sherds from domestic activity accidentally incorporated in grave fills are consistent with this. Other features showing spatial variation, such as “earmuffs” (stones laid either side of the head), can then also be interpreted as being distinctive of particular times. There are no historical references to children, but the preponderance of subadult remains in the eastern part of the cemetery fits the pattern; they may have been foundlings, orphans or the children of poor residents.

Thus, although the relative chronology of parts of the cemetery is to an extent speculative, the demographic and pathological profiles show a division into two distinct phases, the leprosarium and the almshouse, with a somewhat disorganised interface.

In the earlier cemetery 84%of the burials were men, with almost half of these exhibiting some form of leprous change. Of the few women buried here, only two had signs of leprosy. These are minimum numbers for the disease, since there may have been patients with a mild form who died of other causes before the skeleton became affected.

The area of the cemetery attributed to the almshouse phase had a more normal population structure with a mortality rate of 40% before adulthood. That males are slightly more common could indicate that the changeover to admitting women and children was gradual, and there is some evidence that women became more numerous as time passed. Perhaps admission was initially widened to include women but still restricted to lepers. Only 15% of adults buried now were leprous, of whom two thirds were male.

In this later period a much broader range of pathological conditions appears. Bacterial and viral infections would have accounted for most deaths in the pre-antibiotic era, with almost half of all individuals dying during infancy or childhood. People suffering from acute infections are unlikely to have survived long enough to be admitted to the hospital, and what we see are the chronic conditions that are perhaps a more accurate reflection of the inmates’ state of health.

These include tuberculosis, which was rare in the earlier period but is represented by more than 11 individuals in the almshouse phase. Given that tuberculosis only affects the bone in 3–5% of cases, it may have been commoner than leprosy. Other pathologies include the more severe abnormalities present at birth, fractures and metabolic conditions such as scurvy and rickets. Poor health and inadequate nutrition would have made the general population more susceptible to acute infection and debility, and inadequately fed children living in squalor would also have been more at risk of respiratory and gut infections.

There is very little evidence for treatment apart from possible reduction and splinting of fractures, and a single case for the surgical removal of a foot (amputation). The hospital’s function was clearly to provide sheltered accommodation for the infirm rather than treatment for the infirmity.

Medieval leprosy

In an era when every disease had a spiritual dimension, leprosy was in a class of its own. The Old Testament enjoined lepers to dwell “without the camp” (modern scholarship sees this “leprosy” as a spiritual contagion). The Lazarus whom Christ raised from the dead was confused with a beggar covered in sores at the richman’s gate (then thought to be a leper), and Mary of Bethany (the first Lazarus’s brother) with Mary Magdalene. The latter became such a common patron of English leper houses that many were known as “Maudlins”; another term was lazar-house.

Leprosy victims were often denounced by their neighbours. Clergy, civil officers, the parish council (in 18th century Shetland), the barbers (in London) and sometimes confirmed lepers (in 12th century Cologne) could be called upon to identify sufferers. If the symptoms were judged severe enough, the individual had to live in isolation. This was because of a communal fear of spiritual contagion (we know now that most of us have a natural physical immunity). The disease had divine causes, not infrequently being a punishment because of the sexual excesses of victims or their forebears.

Options for the afflicted depended on their resources. The wealthy could isolate themselves at their country estates. Some religious communities offered sheltered accommodation for life in return for a one-off payment called a corrody. Anyone could apply to enter a leper hospital, to spend the rest of their days following a quasi-monastic routine of prayers and, whilst capable, manual labour. Hospitals could be selective about admissions, and as the ultimate sanction inmates could be expelled. Many must have taken to the roads rather than endure such a life, and others seemed to have lived in informal communities at bridges and other nodal points where alms could be sought. Knights could join the Order of St Lazarus and fight the infidel in the Holy Land.

Although all classes could found hospitals, the crown, the higher clergy, the gentry and monasteries accounted for most. Each had its own rules, many based on St Augustine’s. Work, sleep and prayer made up the daily round. Sometimes lepers would be allowed out to gather alms; in other places a healthly brother known as a proctor did this for them. Beside money, benefactors would leave lands that could be farmed directly or rented out, and the less wealthy make gifts of cottages and gardens. Hospitals could be allowed to hold fairs and markets to generate income, and sell surplus garden produce.

Why found or endow a hospital? By the end of the 12th century the doctrine of purgatory had been promulgated: those who had not fully repented on earth could purge their sins after death. The Pope confirmed that God heeded living people’s prayers and could be persuaded to reduce an individual’s time in purgatory. You could shorten your stay by good deeds (such as going on pilgrimage) or by payment to the church (an indulgence worth, say, 300 days’ remission might be bought; this was a major matter of contention at the Reformation). A hospital with eight lepers praying for you daily was a good investment for your immortal soul.

In return, inmates had an adequate diet, bed-rest if necessary and the prospect of a good send-off. The healthy brethren offered spiritual support and dispensed remedies. Exotic concoctions were supposed to cure leprosy (turtle blood, water in which Christ’s feet had been washed, and so on) but the only one normally possible was frequent bathing, for preference in the river Jordan. A curious side-effect of the doctrine of purgatory was a change in lepers’ status. From being reviled as sinners, they became a valuable source of prayers, privileged to suffer purgatory on earth. If borne with Christian fortitude, leprosy allowed them to go straight to heaven. A few healthy individuals even sought the disease to guarantee an afterlife with the angels.

What hospitals did not usually offer were resident physicians or an accident and emergency service. A few came to cater for other specific complaints. In London, St Mary of Bethlehem’s took in the mentally ill (and gave us the word “bedlam”). Others took in pregnant women where difficult births were expected. A very few had schools attached. Those founded for lepers were often taking in others by the 14th century as the disease declined, and became almshouses for the sick poor. Some closed; others economised by taking in the homeless but able-bodied, who were cheaper to look after. A few became chantry chapels, dropping all pretence of good works.

Most hospitals were dissolved at the Reformation. The Chichester hospital survived because it was run by the now-Protestant cathedral and prayers for the dead no longer formed part of its liturgy. By the time of Henry VIII’s reforms it was a very different institution to the original, admitting women and children. The few cases of leprosy are perhaps disproportionately represented, since the closure of other local hospitals left sufferers with no choice of institution. Otherwise, what we have are the skeletons of many of the sick poor of Chichester in the 16th and 17th centuries.

See “Lepers Outside the Gate”. Excavations at the Cemetery of the Hospital of St James & St Mary Magdalene, Chichester, 1986–87 and 1993, ed J Magilton, F Lee & A Boylston (CBA RR158, 2008 / Chichester Excavations 10). John Magilton is an archaeological consultant, Frances Lee is a human osteologist.

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