Saints protectors f rom leprosy: historical hints of suggestive therapy?
ABSTRACT
A short overview of several saints, venerated in Christian tradition as protectors f rom leprosy, is offered as an introduction to a more substantial debate on the possibility and sense of analyzing historical sources and the use of their interpretation for modern medical practice. A possible psychoneuroimmunological mechanism has been advanced to relate some of the healings of leprosy reported in historical materials.RÉSUMÉ
Après une courte introduction traitant de plusieurs Saints vénérés dans la tradition chrétienne comme protecteurs contre la lèpre, cet article présente un débat sur la possibilité et l'intérêt d'analyser les sources historiques, ainsi que sur l'utilisation de leur interprétation pour la pratique médicale moderne. Un mécanisme psycho-neuro-imniunologique a été avancé pour relier certaines guérisons tie lèpre qui ont été rapportées dans les ouvrages historiques.RESUMEN
Se presenta una breve revisión de la literatura sobre varios santos venerados en la tradición Cristiana considerados como protectores contra la lepra. La revisión pretende servir como introducción a un debate más substancial sobre la posibilidad de analizar las fuentes históricas y el uso de su interpretación en la práctica médica moderna. Ya se ha propuesto, por ejemplo, un posible mecanismo siconeuroinmunológico para explicar algunos de los casos de curación de la lepra reportados en varios documentos históricos.The invocation of saints, motivated by the belief that they are able to cure diseases, is a wide-spread phenomenon not only in the popular Christian culture, but in other religions as well. However, the level of "specialization" of certain saints for particular diseases has nowhere reached such variety and sophistication as it did in Christian tradition. These "specializations," often based upon very simple linguistic associations with the saint's name or iconography (10), reveal not only the wit of the common folk, but also the pathology that was prevailing in a certain region, and the ideas about that pathology and fighting it at the times when medical knowledge was generally scarce and unavailable (9).
As in the case of some other diseases and syndromes, leprosy (Hansen's disease) was a target of the "specialization" of several saints. The first description of leprosy in the West was provided not by the Hippocratic Corpus or Galen, but by Avicenna in the l0th century. In the Middle Ages, leprosy was spread all over Europe, but afterward it almost disappeared and became only sporadic, anchored mainly in rural areas. The disease remained present in Scandinavia until late in the 19th century (5,8).
Interestingly, while in the West, leprosy was the symbol of terror, danger, isolation [separatio leprosum (3)], and outcastedness, in Islamic culture, the leper* has neither been exiled nor perceived as repulsive (7).
Reflecting the pathology of the time period, reports of miraculous healings of lepers were not rare in medieval Europe. Departing from the strong belief that a critical analysis of more general historical sources and cultural context can offer relevant hints for the enrichment of the spectrum of modern medical treatment, this paper intends to present a short overview of the most venerated Christian traditional protectors from leprosy and to try to suggest some possible indirect effects of their invocation.
MATERIALS AND METHODS
The following overview of the saints was complied from various literature, while the example of St. Bernardino of Siena's healing was found in primary sources. The criticism of the sources is provided in the Discussion section.
RESULTS
In Christian tradition, the most venerated saints invoked for protection against leprosy or for its cure, are Lazarus, Aegidius (Giles), Sylvester, George and Vincent de Paul.
There are at least two different Lazaruses in Christian tradition. One was Lazarus from Betania, who was resurrected by Christ according to the Gospel of John. Another Lazarus was a poor leper, assisted only by dogs that used to lick his sores. Lazarus' antipode was a rich man caring for nothing but his own pleasure. After they both died, according to the Gospel of Luke, the rich man suffered terrible torments, while Lazarus enjoyed being at Abraham's side. It was this second Lazarus who shaped the cult of the saint venerated for protection against leprosy. An order founded in the 12th century was named after him that provided nursing care for lepers, and the late-medieval quarantine hospitals were named "Lazarettes" (although they were not intended for lepers, but mainly for those infected by the plague) (22).
Aegidius was born in the 7th century in Athens, Greece, but later transferred to the South of Fiance to live as a hermit in a cave. He was wounded in an accident by an awkward royal hunter, and the King, in trying to compensate the hermit, founded a monastery where Aegidius lived until his death in c. 724. Aegidius is most often iconographically presented together with a hind that nourished him with her milk during his hermit life. Following this association, the popular tradition venerates Aegidius also as a protector of lactating mothers. One of the legends on Aegidius mentions his curing lepers by touching them (22).
Sylvester was a Roman bishop and Pope from the 4th century. According to a legend, he cured Emperor Constantine from leprosy after he had persuaded him to accept Christianity (22).
George is the hero of the Golden Legend, telling the story of his killing a dragon that was eating maidens. He died in c. 304 in Palestine after being tortured and beheaded. Beside being the patron of several European nations (England, Germany, Greece, etc.) and cities (e.g., Ferrara), he has been invoked as a protector from herpes, skin diseases, syphilis, and, for unknown reasons, leprosy (14).
Vincent de Paul (1581-1660) was an intelligent peasant from southwest France, who became a priest. During his exciting life, he was enslaved by the Turks and freed after he had converted his owner to Christianity. He organized helping the poor and nursing the sick, and became the chaplain at the royal court. In addition to lepers, prisoners, charitable workers, and many others considered Vincent de Paul to be their patron (14).
Occasionally, many other saints proved to be successful in curing leprosy, although they may eventually have "specialized" in other diseases. A particularly interesting report can be found in the hagiographies of Bernardino of Siena (1380-1444), an excellent popular and innovative preacher who, after he had introduced the cult of a plate with Jesus' name, had to face the accusation of heresy. Bernardino of Siena healed a leper in a story with almost belles lettres characteristics. The leper was given Bernardino's footwear (calceos; sandale) by the Saint himself. After he had left the city, he felt stones in the new shoes. When the leper took off the shoes, he noticed that his legs had been cured up to the knees (ad genua). Shortly afterwards, when he intended to empty the sandals of sand, he noticed that he was cured ad renes (that is, up to the back: strange that one has to remove shoes in order to find out the state of the back). The third time, after having repeated the same procedure, the leper was cured completely (4,6).
DISCUSSION
Thomas Aquinas recognized three groups of miracles. The first group contains phenomena which are not feasible by any natural power (e.g., that the sun reverses its course). Miracles from the second group are events that can occur, but not in this particular subject (e.g., speech in a dog, a man's Hying). The miracles of the third group, on the other hand, are those which are feasible by natural powers, but not in this manner or with this speed (e.g.. the instant cure of a leper) (2).
Analyzing miracles certainly is not an easy task. However, an enormous corps of literature speaks about miraculous healings, relating some of them to the cases of leprosy, and both our scientific consciousness and curiosity prevent us from neglecting them. Some of the cases described probably can be discarded as parabolas and literary topoi that served some other aims than medical reporting. Since the laws regarding the extremely long incubation period of this disease ["early symptoms appear 3 to 5 years after infection, but clinical evidence of infection may appear in as little as 6 months, or as long as 20 years" (5)] were hardly known, it was probably considered a miracle every time someone touched a leper and did not become infected. On the other hand, the disfigured areas of the body are usually covered by lepers; therefore, the leper himself cannot observe the possible gradual declining process. When he/she notices the improvement, immediately after contact with a saint, he ascribes the merit to the invocation, as might have been the case described in the story of St. Bernardino of Siena.
Indeed, some cases of real healing probably occurred, since it is well-known that the lesions caused by tuberculoid leprosy, a less malignant form than the lepromatous, may heal spontaneously(12). But, as an infectious disease, leprosy certainly must also be influenced by the psycho-neuro-immunological axis. It was Rossi and Cheek who stirred up our modern, scientifically-based interest in the topic of the use of suggestion in medical treatment. The limbic-hypothalamic system has been defined as "the locus of information transduction from the neural incoding of the languages of the mind (thoughts, sensations, etc.) into the messenger molecules" (21). The hypothalamus was shown to be able to activate the sympathetic-system control centers via the lower brain-stem relay stations (heart rate, blood pressure, body temperature, gastrointestinal activity, etc.) (20). Hypothalamic nuclei are directly connected with the pituitary gland as well, thus opening new pathways for influencing the entire endocrine system. The hypothalamus itself sifts oxytocine and vasopressine, deposing them into the rear pituitary lobe, while the releasing factors such as CRF, GHRF, TRH, CRIT etc., produced by hypothalamus, dictate the release or inhibition, respectively, of the release of the anterior-pituitary hormones such as ACTH, prolactin, etc., which control the reproductive, sexual, metabolic, and vegetative body regime (16). By using these connections with the sympathetic and endocrine system, suggestions can (always via the hypothalamus) provoke significant reactions of the immune system as well. The major immunoregulatory organs (lymph nodes, spleen, thymus) are furnished plentifully with the nerve fibers of the autonomic system (19). Certain hypothalamic lesions were found to provoke suppression in the number of the splenocytes and thymocytes and to result in a decrease in antibody production ('). Cells secreting In-terleukin-1, the neuromodulator with immunological effects and a possible role in healing neural damage, have also been found in the hypothalamus (19).
Obviously, modern science has collected significant evidence that suggestion may be able to influence health and disease. Where might the suggestive power of the saints/ protectors originate? It is to be assumed that a major role in believing in miraculous cure was the conception of the development of disease, and, hence, of its elimination. In the Middle Ages, the appearance of the disease was mainly attributed to moral causes [i.e., sins (5)]. To that supposition, one has to add a constant referral to Biblical and other parabolas claiming that the cure was possible, as well as the fact that most of the saints have disposed of various suggestion-conducive characteristics (i.e., unusual physical marks, bizarreness, or even psy-chopathological traits). Some saints, like St. Francis of Assisi, even used to evoke popular adoration by kissing lepers. The mind of a leper certainly was prepared to receive a suggestive influence. After all, having been proclaimed "dead unto the world, but alive unto Christ" and having already left all private property to the heirs (18), the leper did not have much to lose.
There were even saints, like St. Abbo, who, quite prophetically, instructed lepers that "only the lepers' own faith can cure them" (13). SS Cyr and John composed a witty "test of faith," requiring the patients to load themselves with a donkey pack-saddled and to shout, "I am an imbecile, completely deprived of intelligence!," or to slap the face of the first passerby, or to eat a poisonous snake, or to dig himself into the sand of a neighboring beach. It was said in the same legend that a leper, who had been advised to cover his body with camel dung, did cover his body, but not his face and. therefore, only on his face, leprous traces remained (17). For practicing their "method," SS Cyr and John were accused of using the well-known Hippocratic and Galenian remedies, and to us, this approach seems very original, and correctly based on the suggestion-healing principles.
As expected, in our short overview of traditional Christian saints invoked for protection against leprosy, one encounters only ancient and medieval saints (Vincent de Paul being the youngest one), which coincides well with the presence of leprosy in Europe. It is, however, essential to remember that, since leprosy has been even more constantly present in other parts of the world, the reports of miraculous healings can be found in other religions and cultures as well. In the opus on the life and deeds of Sri Caitanya, there is mention of the leper Vasudeva, who came to the house of Kurma to see Caitanya Mahaprabhu, but he (Vasudeva) heard that the Lord had already left. "When Vasudeva started to moan for not having seen Caitanya Mahaprabhu, the Lord came back and embraced him. As soon as the Lord touched him, both his leprosy and his misfortune disappeared." (15) Maybe under Christian influence, in certain regions (Nepal and Punjab, for instance) Muslin saints specialized as well, e.g., Sakhi Sarwar for eye complaints, Makhdum Sahib for eye diseases and exorcisms. Shaikh Saddu for melancholy, Guga Pir and Madar Shah for snake bite, Pir Jahaniya for leprosy, etc. (11).
In conclusion, we would like once again to stress the importance of a critical approach to historical medical and nonmedical sources. However, as we hope to have proved by this paper, those materials may become a precious source of modern medical considerations. Present scientific knowledge on psychoneuroimmunological interactions may shed important light on medieval miracle reports. Hopefully, those reports might provide suggestions for enriching modern medical treatment and, in particular, for increasing the successful bondage between patient and physician.
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1. M.D., M.A., Ph.D., Laboratory of Neurophysiology, Department of Psychiatry, Harvard Medical School, Massachusetts Mental Health Center, 74 Fenwood Road, Boston, MA 02115, U.S.A.
2. M.D., M.Sc., D.Sc. Department of History of Medicine, School of Medicine, University of Rijeka, Rijeka, Croatia.
3. D.D.S., M.Sc. Department of History of Medicine, School of Medicine, University of Rijeka, Rijeka, Croatia.
4. M.D., Health Center Rah. Rah.Croatia.
Reprint requests to:
Dr. Amir Muzur
at the above address or Telephone: 617-626-9475; Fax: 617-73.1-7851
E-mail: astir enuur@hmis.parvttrd.edu
Received for publication on 9 July 2002.
Accepted for publication on I August 2002.
* In this paper, the term "leper'' is used only because it was necessary for historical accuracy. The authors are fully aware of the otherwise inappropriateness and unacceptability of this terns.