This thesis analyses the development of the hospitals and leprosaria in Narbonne and Siena from their foundation to the Black Death (1080-1348). Specifically, it examines their respective relationships with the people of Narbonne and Siena and the municipality within a comparative framework. This thesis helps address the gap in comparative studies of the history of hospitals and leprosaria. This comparative study demonstrates how the internal governance of these institutions responded to — and were indeed shaped by — changes in the political and social climate of Narbonne and Siena. This becomes apparent through a comparison of the Hospital of St Just and Hospital of St Paul in Narbonne with the Ospedale di Santa Maria della Scala in Siena. While all these houses were established by ecclesiastical institutions between the late eleventh and mid-twelfth century, there is a marked difference between the growth of the Ospedale and that of the institutions in Narbonne. Furthermore, the Ospedale's independence from its founders, coupled with Siena's wealth and population, facilitated its development into a paragon of the medieval hospital. Such elements are absent from Narbonne, which was entering a period of decline in the thirteenth century. This thesis also recontextualises the study of leprosaria in both cities by deconstructing the traditional exclusion narrative; indeed, this study presents the first examination of the lepers and leprosaria in Siena. Examination of these two cities reveals that there were various approaches to supporting and regulating lepers. It also demonstrates that lepers and leprosaria played an important role within the urban environment, by providing lepers a community while also presenting the healthy with an opportunity to serve them and reap spiritual benefits. This thesis provides a comprehensive analysis of the institutional development of assistive houses in these two cities, placing them in their respective political and social contexts and evaluates the relationship of these assistive institutions with authorities, especially the episcopacy, papacy, and municipality.

The oral histories utilized by this research reveal the experiences of those who suffered leprosy in five South Pacific nations, Fiji, New Caledonia, Samoa, Tonga and Vanuatu. This thesis explores how leprosy and its stigma impacted on the lives of these people, some of whom suffered decades of isolation at various leprosaria including the case of one New Caledonian resident for nearly seventy years. The testimonies of their experiences of diagnosis, removal into isolation, medical treatment and eventual discharge back to their homes implicitly contain descriptions of attitudes of stigma in their communities. This research reveals that where there is openness and knowledge about the minimal risk of leprosy contagion, as occurred in Fiji and Vanuatu from the 1950s, less stigma is attached to the disease. Nevertheless even in these countries, prior to the 1950s and availability of any effective medication, the fear and horror of the physical effects of leprosy was such that the victims were either cast out or chose to move away from their homes. This segregation led to groups of leprosy sufferers banding together to help care for each other. Once the policy of isolation in leprosaria was implemented, advanced cases of leprosy benefited from the better medical facilities and found opportunities for friendships and camaraderie. However, where the conditions at leprosaria were miserable and movements of the residents visibly restricted by fences, as occurred in Samoa and Tonga, there was heightened leprosy stigma. Perceptions of stigma varied from person to person and region to region. Higher levels of stigma were evident in New Caledonia, where leprosaria had been situated at former prison sites and strict isolation enforced, and in Tonga, where the removal of all leprosy sufferers had from the earliest days been associated with biblical strictures asserting that leprosy was a curse and the sufferers unclean. Following the availability of sulphone treatment in the South Pacific in the1950s and the improved medication in the 1980s, leprosy need no longer be physically disfiguring or disabling. Assisted by the generous donations gathered by the Pacific Leprosy Foundation in New Zealand to the medical services at the central leprosy hospital in Fiji, and by direct assistance to leprosy sufferers in the Pacific, the disadvantages that were imposed by leprosy in the past are disappearing and as one contributor to the project said ‘the time of darkness’ is ending.

This thesis aims to outline the causes, symptoms, and treatments related to leprosy, and how it can be diagnosed in patients and identified in human remains. The thesis also aims to demonstrate the ways in which care for leprosy sufferers developed as the disease became more prevalent and more commonly, and correctly identified. It analyses the social stigmas inflicted upon sufferers, and the medical care and attention provided for them by religious institutions when other groups or organisations shunned those suffering from leprosy. The rationale for this study is to identify trends surrounding the social stigmas attached to leprosy and care from the first identifiable case of strain three of Mycobacterium leprae in the 1st century AD to the late Middle Ages when the number of cases of leprosy appears to begin to decline. Using archaeological evidence, historical records, and the published research of experts in the field, this thesis demonstrates that as leprosy spread throughout the Middle East and Europe, religious organisations often took on the role as care givers for leprosy sufferers through the ideal of religious, often Christian, charity; to look after the poor, sick, and needy. As the trends presented in this study have yet to be published elsewhere in this way, this thesis aims to contribute via an interdisciplinary approach to the fields of religious archaeology, anthropology and bioarchaeology.

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