it is mykel to be taken hede aboute the examynynge and the dome of leprouse men, that is the moste iniurie (i. wrong) to sequestre or withdrawe tho men that schulde not be sequestred or withdrawen and leve leprouse men with the peple, for-whye it is a contagiouse sekenesse and infectynge. And therfore a leche that shal deme ham, he schall ofte byholde ham and turne and unturne the tokenes.76
[It is much to be heeded in the examination and judgment of leprous men, that it is the greatest injury, or wrong, to sequester or withdraw those men that should not be sequestered or withdrawn, and to leave leprous men among the people since it is a contagious and infecting sickness. And therefore a medical practitioner who shall judge them, he shall often behold them and consider and reconsider the signs.]
A failure to diagnose would endanger those who do not have leprosy, while a “false positive” would unjustly force the patient to withdraw from social life. In response to these risks, Guy urges greater observational and interpretive effort, “turning and unturning” the symptoms. Indeed, the medieval medical accounts of leprosy consistently emphasize the painstaking labor of diagnosis.
One diagnostic treatise, often attributed in manuscripts to the fourteenth-century Montpellier physician Jordan of Turre, suggests that the examiner organize his observations according to a carefully rational scheme: “Proceed as follows: take a tablet and write the good signs on one side and the bad signs on the other, and you will not become confused.”77 Many treatises divided symptoms into “equivocal” and “unequivocal” categories, so that an examiner would not be misled by a signum fallax.78 But even those distinctions were uncertain. In his Lilium medicinae, the Montpellier physician Bernard of Gordon (d. c. 1318) includes an extensive discussion of dubia, or doubtful matters, in his chapter on leprosy. At one point he recalls a patient who had fingers and toes “so deformed, disfigured, and falling apart that they had only one joint left.” Yet over the course of twenty years, no facial symptoms appeared. While Bernard treated the man for leprosy, the physician changed his diagnosis in retrospect, since facial disfigurement is such an “unequivocal” sign: “Therefore, I guess, with conjecture in approximation of the truth, that it was not leprosy and that it could not have lasted for so long without disfigurement of the face. Even though I had once believed differently, now, after having labored diligently in this work, I am of another opinion and now I would not declare someone [like him] leprous. However, God knows the truth, I do not know.”79 Bernard’s account is striking for its fretful uncertainty. Despite the spectacular disfigurements for which leprosy was known in hagiography and other literary representations, within learned medicine its discernment was treated as a difficult and anxious task.80
The volatility of leprosy’s diagnosis is evident in a Chancery warrant from 1468. Written by three physicians of Edward IV, “William Hatteclyff, Roger Marshall and Dominic de Serego, doctors of Arts and Medicine,” the warrant responds to an earlier petition demanding the removal of “Joanna Nightingale of Brentwood in the county of Essex from general intercourse with mankind, because it was presumed by some of her neighbors [ex vicinis suis] that she was infected by foul contact with leprosy [foeda leprae contagione infectam] and was in fact herself a leper.”81 Joanna apparently refused to accept this initial diagnosis and call for sequestration, and so a writ was prepared on account of the “grievous injury [grave dampnum]” and “manifest perils [periculum manifestum]” of her ongoing presence. The writ instructed the sheriff of Essex to assemble a common-law jury to make Joanna’s diagnosis legally binding:
having taken with you certain discreet and loyal men [discretis et legalibus hominibus] of the county of the aforesaid Joanna, in order to obtain a better knowledge of her disease, you go to the aforesaid Joanna and cause her to be diligently viewed and examined [facias diligenter videri et examinari] in the presence of the foresaid men. And if you find her to be leprous, as was recorded of her, then that you cause her to be removed in as decent a manner as possible, from all intercourse with other persons, and have her betake herself immediately to a secluded place [locum solitarium] as is the custom, lest by common intercourse of this kind injury or danger should in any wise happen to the aforesaid inhabitants.82
As the writ indicates, the diagnosis that was initially “presumed” (praesumeretur) by her neighbors could be formalized and made binding by a local jury. Joanna was to be “diligently viewed and examined” in the jury’s presence, though no mention is made of who should lead the examination. This initial writ is unconcerned with medical learning, and laymen and common law are treated as sufficient arbiters. Instead of medical expertise, the writ focuses on the perceived dangers to the community and to the customary status of sequestration.
However, Joanna was apparently supplied with friends in high places as well as suspicious neighbors. After the issue of the first writ, the Bishop of Bath and Wells and Lord Chancellor Robert Stillington (d. 1491) requested that the king’s own physicians examine Joanna. They agreed and described their diagnostic exam in a second Chancery writ, which stressed the exam’s methodical and learned character. As the writ recounts, “We examined her person, and, as the older and most learned medical authors have directed in these cases, we touched and handled her and made mature, diligent, and proper investigation whether the symptoms indicative of this disease were in her or not [de persona sua consideravimus, et juxta quod antiquiores et sapientissimi medicinae auctores in hujusmodi casibus faciendum docuerant, ipsam tractavimus et palpavimus, per signa, hujusmodi morbi declarativa, discursum fecimus, si in ea reperirentur mature diligenter et prout oportuit inquisivimus].”83 The physicians provide their reader, nominally Edward IV, some background information to appreciate their method: “We are taught by medical science that the disease of leprosy is known by many signs [Docemur equidem ex scientia medicinali morbum leprae in communi per plurima signa].” And so, they continue
in the case of the woman brought before us, upon going through upwards of twenty-five of the more marked signs of general leprosy we do not find that she can be proved to be leprous, by them or a sufficient number of them. And this would suffice, generally, to free her from the suspicion of leprosy, since it is not possible for any to labor under the disease in whom the greater part of these signs are not found [in hoc casu, mulieris nobis oblatae per viginti quinque & ultra signa leprae in communi famosiora discurrentes, non invenimus ipsam ex illis aut eorumdem sufficienti numero posse convinci leprosam, tt hoc quidem generaliter pro liberando ipsam a dicta praesumptione sufficeret, cum non sit possibile leprae morbo quempiam laborare in quo non multa pars hujusmodi signorum reperiatur].84
We can discern in this passage the influence of treatises like Jordanus of Turre’s, with its instructions to notate symptoms on a chart of “good signs” and “bad,” as well as Bernard of Gordon’s careful parsing of equivocal and unequivocal signs. The physicians even recount an otiose further step in their exam, when they search for the symptoms of leprosy’s four subvarieties: “going through upwards of forty distinctive signs of the different varieties of leprosy, we do not find that this woman is to be marked as suffering under any of the four kinds, but is utterly free and untainted [liberam prorsus et immunem].” They conclude their diagnosis, “We are prepared to declare the same more fully to your highness by scientific process [per processum scientificum], if and wherever it shall be necessary.”85 With this last statement they promise an even greater display of learned rigor, should the occasion demand it.
In this document, then, the practice of bodily interpretation appears in its deeply social aspect. Joanna’s neighbors are the first to diagnose her, drawing on the traditions of sequestration in canon law (and ultimately Mosaic Law) as well as novel rhetorics of contagion.86 It is impossible now to determine the reasons behind this initial diagnosis. Were there visible symptoms that called for it, or was it motivated by the desire to lay hold of a woman’s property, or to bridle her willful behavior? Joanna’s neighbors, finding their diagnosis ignored, petitioned the court of Chancery to lend it legal