The Domus Leprosorum in Crusader Jerusalem
© 2005 C. Savona-Ventura,
The origins of the Military and Hospitaller Order of Saint Lazarus is shrouded in a haze of myth and legend. The problem has been further compounded by the loss of essential documents from the ravages of wars and time. The Order’s presence was a definite reality after the conquest of Jerusalem on the 14th July 1099 by the Crusaders under the leadership of Godfrey of Bouillon. The re-organization initiated in the hospitaller services available in the Holy City resulted in the setting up of two hospitaller Orders, both adopting the Rule of Saint Augustine. The first Order, assuming the patronship of St. John, became responsible for hospitaller and hospice services to pilgrims and the sick. The second Order assumed the patronship of St. Lazarus and was responsible for caring for sufferers of leprosy. Both Orders owned separate edifices – the former within the walls of the city near the Holy Sepulchre1; the latter just outside the walls of the city.
The Jerusalem leprosarium, or Domus Leprosorum as it came to be called, may have been established prior to the Crusader’s conquest. In 1565, Pope Pius IV in his Bull Inter Assiduas acknowledged a link between the Order of Saint Lazarus of Jerusalem with Saint Basil the Great (born c.329 AD; died 379 – succeeded as Bishop of Caesarea 370) who had established a leprosarium in the city of Ptolemais (now Acre). These services were gradually expanded by assuming responsibilities for further establishments in Jerusalem, Bethlehem and Nazareth. A leper hospital had been established in Jerusalem by the Empress Eudoxia, wife of Arcadius (383-408 AD). However a direct link between the 4th century hospital and the 11th century establishment remains doubtful.
The two hospitaller Orders in Jerusalem maintained close contact and may in fact have been initially different elements of one unit, originally sharing one common Master – Blessed Gerard, le Fondateur (accession 1099 – died ~1120). Under the Mastership of Gerald, the Order of St. John, known as Fratres Hospitalarii, received formal recognition by Pope Paschall II in 1113. The Act of Foundation for the Order of St. Lazarus was according to tradition set out by Paschall II in 1115. Presumably this would have been similar to that issued two years earlier setting up the Order of St. John which simply concluded “that the House of God the Xenodochium (or hospice) shall always be under the guardianship of the Apostolic See and the protection of Blessed Peter” 2. Gerald’s successor as Master of the Lazarite Order was Boyant Roger (a.1120–d.1131) who had served as Rector to the Hospital of St. John under Blessed Gerald. Raymond du Puy was appointed Master of the Hospitallers of St. John (a.1120–d.1158/60). Boyant Roger was succeeded by four relatively unknown Masters – Jean (a.1131–d.~1153), Barthélémy (~1153), Itier (~1154), and Hughes de Saint-Pol (~1155–d.1157). Hughes was eventually succeeded by Raymond du Puy (a.1157–d.1158/60), the incumbent Master of the Hospitallers of Saint John3.
The mid-12th century saw the formal organization of both Orders with Statutes being drawn up for the Order of St. John by Raymond du Puy in ~11504 and for the Order of St. Lazarus possibly by Barthélémy in ~1154. From the fragmentary survivals of the latter statutes, it appears that these sought the advice of a rival religious Crusader Order – the Order of the Temple – established about 1118 and receiving recognition by the Council of Troyes in 1129. It has been suggested that Barthélémy may in fact have been a Templar knight who left the Order to reap the rewards of ministering to the sick5. Subsequent late 12th century Masters of the Order of St. Lazarus in Jerusalem included Rainier (~1164), Raymond (~1168), Gerard de Montclar from Auvergne (~1169), and Bernard (~1185-1186) 6. Jerusalem was lost to Sultan Saladin after the battle of Hattim in October 1187 and the three Orders transferred their headquarters to Acre in 1191 after this was regained by the Third Crusade.
The first three decades of the 12th century saw the Order of St. Lazarus gradually increased its influence in the Holy Land. In 1142 King Fulk of Anjou donated land in Jerusalem to “the church of St. Lazarus and the convent of the sick who are called miselli” 7. A description of the Holy City in 1151 places the leper hospital “outside the walls of Jerusalem between Tancred’s Tower and Saint Stephen’s Gate” 8. In addition a female Convent of St. Lazarus was extant in Bethany. This convent was extant by 867 A.D. when it is mentioned by Bernard the Wise in his pilgrim travelogue9. This convent is further mentioned by the 12th century chronicler William of Tyre. The chronicler records that Princess Sibylla had been raised in this convent under the direction of the abbess who was the maternal aunt of King Fulk10. The village of St Lazarus, which belonged to the canons of the Holy Sepulcher, seems to have been settled by clientes, who held been awarded feuda or fiefs. An act of 1129 mentions a holder of a fief, a confrater of St Lazarus, whose daughter was to marry a nutritus famulus of the canons11.
No contemporary descriptions of the Jerusalem leprosarium are extant, but the edifice has been depicted in a 1717 Dutch map (engraving 20.0x32.9 cm) by Franciscus Halma (1653-1722) entitled De Stadt JERUSALEM als zy Hedendaeghs bevonden wordt (see figure and detail below). This map, showing a traditional bird's-eye view of Jerusalem from the east, was based on an on-site drawing made in 1578. It presents an accurate picture of the city as it appeared after the walls were rebuilt by Suleiman the Magnificent (1520-1566), the same walls that surround the Old City today. Numbered legends at the bottom identify 45 holy sites and historical landmarks. Building No. 37 situated outside St. Stephen Gate, labeled “Net Zeiken Huys” (Dutch ziekenhuis = hospital, infirmary) is presumed to depict the Leper’s Hospice12
16th century view of the Medieval City of Jerusalem and a detail of the Domus Leprosorum
(source: Franciscus Halma, 1717 based on c.1578 view)
The seal of the Domus Leprosorum shows a priest holding a crosier and the inscription “St. Lazarus of Jerusalem” on one side; on the other side is a leper holding a clapper with his face covered in spots and the inscription “The seal of the leper”13. The seal may be intended to illustrate the dual nature of the 12th century Order’s organization based on monkish (Church of St. Lazarus) and sick (convent of the sick) members as defined in King Fulk’s 1142 land donation. Unlike the inmates of the hospital run by the Order of Saint John who were generally merely needy visitors; the lepers cared for by the leprosarium run by the Lazarite Order were condemned to perpetual seclusion from the outside world. Such was the degree of seclusion imposed on lepers that the third Lateran Council of 1179 found it necessary to comment that “Although the Apostles says that we should pay greater honour to our weaker members, certain ecclesiastics, seeking what is their own and not the things of Jesus Christ, do not allow lepers, who cannot dwell with the healthy or come to church with others, to have their own churches and cemeteries or to be helped by the ministry of their own priests. Since it is recognized that this is far from Christian piety, we decree, in accordance with apostolic charity, that wherever so many are gathered together under a common way of life that they are able to establish a church for themselves with a cemetery and rejoice in their own priest, they should be allowed to have them without contradiction. Let them take care, however, not to harm in any way the parochial rights of established churches. For we do not wish that what is granted them on the score of piety should result in harm to others. We also declare that they should not be compelled to pay tithes for their gardens or the pasture of animals” 14.
The Domus leprosorum was run by a master, almost invariably a priest, who was assisted by nursing brothers and sisters. In some leper hospitals of the Middle Ages even the master had to be chosen from among the lepers. It is not proved, though it has been asserted, that this was the case at Jerusalem. It has been maintained that Article V of the ancient statutes of the Order lays down that “The chief of the Order shall be taken from this side of the sea; he shall be a healthy knight” 15. However, this rule may in fact date to a later period when Pope Innocent IV in 1253 altered the rules of the Order at the request of the brothers to permit “any healthy knight from amongst the brothers of the house” to be appointed master-general since according to Robert de Nantes, Patriarch of Jerusalem “all the leper knights of the house of St. Lazarus were killed” in the Battle of Gaza against the Khwarizmians at La Forbie in October 124416. This military disaster was further confirmed by the chronicler Matthew Paris17.
The leper patients were also regarded as brothers or sisters of the house which sheltered them, and obeyed the common rule which united them with their religious guardians. As full members, the inmates thus had a say in the management of their affairs. The members of the convent lived in two sets of accommodation, one for healthy brothers and one for lepers, who ate and slept separately. The day was governed by a strict horarium based around services and meals, and punishments were imposed on transgressors of the rule. The hospital provided little or no attempt at curing its sickened inmates further than furnishing a good diet, comfortable sleeping quarters and relieving their suffering by bathing. The hospital probably could accommodate up to a thousand people under the supervision of the warden, providing them with clothing, shelter and care – though most of these were temporary residents possibly pilgrims or migrant lepers visiting Jerusalem18. The hospital code for the Jerusalem leprosarium has not survived, but it probably was similar to Ancient rules of the Leper Hospital of Saint Mary Magdalene in Dudstone just west of Gloucester, U.K. attributed to Bishop Ivo of Chartes (d.1115). The Saint Mary Magdalene Leprosarium in Dudston was not managed by the Order of Saint Lazarus, but was dependant on the Llantony Priory whose followers adopted the Augustinian Rule. It was founded in 1127 and housed 13 lepers.
The Dudston constitutions were primarily intended to create good order and a purposeful life in a complex residential institution. They were not concerned with medical requirements. The regulations thus fostered a monastic pattern in the leper community. Male and female patients followed regular schedules that included frequent prayer and periodic silence. Men and women were to avoid becoming romantically involved with one another, and members were forbidden to run about unaccompanied. Clothes were uniform; food was plentiful with meat being supplied three times a week, though occasional fasting was prescribed. A formal promise of stability was required and disciplinary measures were specified. Allowance for physical infirmity was however made and the bedridden were granted special privileges19.
The Domus leprosorum received all leper patients whatever their social status. The Livre au Roi, the legal code of the Latin kings drawn up c.1198-1205, required any knight with leprosy to join the convent of St. Lazarus “where it is established that people with such illness should be” 20. Similarly, the rules of the Order of the Temple required any knight infected with leprosy to leave the respective Order and join the brethren of Saint Lazarus. Templar Rule No. 443 in the Regle du Temple states that “When it befalls any brother that, by the will of Our lord, he contracts leprosy and the thing is proven, the worthy men of the house should admonish him and ask him to request permission to leave the house and go to Saint Lazarus, and take the habit of a brother of Saint Lazarus” 21. Grandmaster Hugues de Revel (1258-1277) of the Order of Saint John established the statute that “if in any country there be a Brother who is a leper, he may not wear the Habit from that time forward, and may not come among the Brethren, but he should be provided with food and clothing” 22.
The increasing presence of leper knights in the Order and the changing politics in the Holy Land after 1123 required the setting up of a military fraction of the Order of St. Lazarus with the aim of contributing towards the defense of the Holy Land from the forces of Islam. Saint Bernard of Clairvaux may well have had the Lazarite knights in mind when in 1129 he admonished Crusader knights “to hear matins and the whole of the divine service, in accordance with canonical institution and the custom of the regular masters of the holy city. For that reason it is especially owed by you, venerable brothers, since despising the light of the present life, being contemptuous of the torment which is of your bodies, you have promised in perpetuity to hold cheap wordly matters for the love of God: restored by the divine flesh, and consecrated, enlightened and confirmed in the Lord’s precepts, after the consumption of the divine mystery no one should be afraid to fight, but be prepared for the crown” 23.
The Battle of Hattim at Tiberias in 1187 was to be the turning point for the Crusader Kingdom of Jerusalem and Sultan Saladin pressed his advantage to re-conquer Jerusalem. With rare mercy, Saladin allowed the garrison of Jerusalem to march out in three parties from the postern near Saint Lazarus24. The Order of St. Lazarus, together with the other Crusader forces, transferred its headquarters to Arce, where it owned a hospital and convent outside the city walls. The buildings were incorporated into the northern suburb of Montmusard after Louis IX extended the fortifications of Acre in the 1250s. In Acre, the Lazarite knights continued succoring lepers and maintained their military duties in the defense of the Holy Land. In 1255 Pope Alexander IV spoke of “a convent of nobles, of active knights and others both healthy and leprous, for the purpose of driving out the enemies of the Christian name”; while in 1259, Matthew Paris included the Lazarites among the “defenders of the church fighting in Acre” 25. The Lazarite knights actively participated in a number of local and general campaigns against the forces of Islam including the Battle of Gaza (1244), the Seventh Crusade in Egypt (1248-1250), the Syrian Campaign (1250-1254). The Lazarite Order also became involved with inter-Orders political conflicts26.
While maintaining its convent in Acre, the Order in 1254 transferred its Magisterial headquarters to France with the consent of Pope Alexander IV and King Saint Louis IX of France. This anticipated the eventual fall of the last Crusader outpost in the Holy Land27. The final death toll to the Crusader Kingdom of Jerusalem came in April 1291 when the Saracen army under the leadership of Sultan Khalid laid siege to Acre. In spite of a spite of the bravery of the defending forces, the last Latin stronghold fell to the Saracen onslaught on the 14th May. All the military brethren of the Order of Saint Lazarus present at Acre were killed during the defense.
The earlier transfer of the Magisterial headquarters of the Order to Western Europe before the expulsion from Acre enabled it to survive throughout the centuries in spite of several attempts at incorporating its holdings with politically more powerful Orders. The Military and Hospitaller Order of Saint Lazarus of Jerusalem has during the last century expanded its philantrophic activities on a worldwide level, inclusive the Maltese Islands. The Order maintains its contribution in the fight against leprosy in countries still plagued by the infection.
St. Louis Hospital, Jerusalem
The Jerusalem Domus Leprosorum run by the Order of Saint Lazarus suffered from the ravages of time and Islam occupation throughout the centuries. The area now hosts the forty-four bed St. Louis Hospital that serves as a hospice for persons with advanced disease and is sponsored by the French Sisters of St. Joseph.
Hansen Hospital, Jerusalem
Jerusalem still hosts a Leprosy Centre called Hansen Hospital with thirty beds, even though leprosy today is rare and non-endemic in Israel. However, cases of leprosy are invariably imported by immigrants or foreign workers arriving from endemic areas. Similarly in Malta, leprosy has been more or less sufficiently controlled to enable the closure of the last leprosarum at Hal Ferha Estate in Gharghur.
The Grand Priory of Malta of the Order of St. Lazarus had regularly maintained its traditional support to the leprosaurum in Malta and in countries where the disease is still particularly rife, such as Kenya and Tanzania.
Leprosy remains an edernic destructive desease in many third world countries today. The Military and Hospitaller Order of Saint Lazarus of Jerusalem has retained its original raison s'entre and continues to support efforts to treat those affected with leprosy and to help eridate the infection. It has also expanded its hospitaller further affield supporting various noteworthy initiatives.
 C. Savona-Ventura: The first hospital of the Order of St. John of Jerusalem. It-Tabib tal-Familja – Journal of the Malta College of Family Doctors, 1999, 17:p.17-21
2 E.E. Hume: Medical Work of the Knights Hospitallers of Saint John of Jerusalem. John Hopkins Press, Baltimore, 1940, p.26; J.J. Algrant, J. Beaugourdon: Armorial of the Military and Hospitaller Order of Saint Lazarus of Jerusalem. van den Akker, Delft, 1983, p.464-465.
3 J.J. Algrant, J. Beaugourdon, 1983: op. cit., p.337.
4 E.J. King: The Knights Hospitallers in the Holy Land. Methuen, London, p.324-328
5 D. Marcombe: Leper Knights. The Order of St Lazarus of Jerusalem in England, 1150-1544. Boydell Press, Woodbrige (U.K.), 2003, p.8-9; M. Barber: The Order of St Lazarus and the Crusades. The Catholic Historical Review, July 1994, 80(3):p.439-456.
6 J.J. Algrant, J. Beaugourdon, 1983: op. cit., p.464-465
7 A. de Marsy (ed.): Fragment d’un Cartulaire de l’Ordre de Saint-Lazare en Terre Sainte. Archives de l’Orient Latin, 2 Paris, 1884 (reprint: New York, 1978), p.123-124
8 J.J. Algrant, J. Beaugourdon, 1983: op. cit., p.330
9 The Voyage of Bernard the Wise A.D. 867. In: T. Wright (ed.): Early travels in Palestine. Dover Publ., New York, 2003 (originally published: H.G. Bohn, London, 1848), p.28
10 J.J. Algrant, J. Beaugourdon, 1983: op. cit., p.330; William of Tyre: Historia rerum in partibus transmarinis gestarum, XXIII, 1, Patrologia Latina 201, p.890-92, translated by J. Brundage: The Crusades: A Documentary History, Marquette University Press, Milwaukee, WI , 1962, p.148-50. The Medieval St. Stephen’s Gate is today’s Damascus Gate. The Crusader remains of Tancred’s Tower (or Goliath’s Tower) are still found outside the walls of Jerusalem today.
11 N.P. Zacour, H.W. Hazard, editors: A History of the Crusades. Vol. V: The impact of the Crusades on the Near East. University of Wisconsin Press, Madison, Wisconsin, 1985, p.162
12 Franciscus Halma: De Stadt JERUSALEM als zy Hedendaeghs bevonden wordt (map engraving 20.0x32.9 cm). Leeuwarden, Netherlands, 1717.
13 D. Marcombe, 2003: op. cit., p.5; S. Shahar: Des lepreux pas comme les autres. L’ordre de Saint-Lazare dans le royaume latin de Jerusalem. Revue Historique, January-March 1982, 541:p.31-32; C. Clermont-Ganneau: 1. Seal of the crusading period, from the leper hospital of St. Lazarus at Jerusalem. Palestine Exploration Fund Quarterly Statement for 1901, p.109 - 113
14 N.P. Tanner (ed.): THIRD LATERAN COUNCIL (1179) - Introduction and translation taken from Decrees of the Ecumenical Councils. Provided Courtesy of: Eternal Word Television Network http://www.ewtn.com/ (accessed 9th May 2005)
15 J. Riley-Smith: Hospitallers. The History of the Order of Saint John. Hambledon Press, London, 1999, p.22-24
16 D. Marcombe, 2003: op. cit., p.13-14
17 H. Nicholson: Extracts from the chronicles of Matthew Paris relating to the Templars, Hospitallers, and Teutonic Knights translated from the Rolls Series editions by Helen Nicholson. 1989 (Internet site: www.cf.ac.uk accessed 24th December 2004): Matthew Paris: Flores Historiarum (taken from H. R. Luard, Rolls Series 95, London, 3 vols, 1890, vol. 2:p.272).
18 D. Marcombe, 2003: op. cit., p.9
19 Registrum Magnum is P.R.O., Ms. C 115/K 2/6683 (formerly called C 115/A 1): as reported by E.J. Kealey: Medieval Medicine. A Social History of Anglo-Norman Medicine. J. Hopkins University Press, Baltimore, p.108-109, 200-201.
20 A.A. Beugnot (ed.): Le Livre au Roi. Assises de la Haute Cour, Recueil des Historiens des Croisades, Lois. Paris, 1841, 1:p.636-637; D. Marcombe, 2003: op. cit., p.11
21 H. de Curzon (ed.): La Regle du Temple. Societe de l’Histoire de France, Paris, 1886, p.239-240
22 E.E. Hume, 1940: op. cit., p.62
23 Baron of Richecourt: A living document on Templar Quotes, Statements and Writings. http://www.ordotempli.org/ancient_templar_quotes.htm (accessed 8th May 2005).
24 The Old French Continuation of William of Tyre, para.57 as translated in P.W. Edbury: The Conquest of Jerusalem and the Third Crusade. Sources in Translation. Ashgate, Aldershot, 1998, p.63.
25 E.J. King, op. cit., p.33; D. Marcombe, 2003: op. cit., p. 12,14
26 H. Nicholson, 1989: op. cit. - Matthew Paris: Chronica Majora (taken from H. R. Luard, ed., Rolls Series 57, London, 7 vols, 1872-84, vol.2:p.365; vol.5:p.196,745-746); Historia Anglorum (taken from F. Madden, Rolls Series 44 London, 3 vols, 1866-9, vol.2:p.90,95); E. Wedgwood: The Memoirs of the lord of Joinville. A New English Version. http://www.ordotempli.org/memoirs_of_the_lord_of_joinville. htm (accessed 8th May 2005), p.277-279
27 E.J. King, op. cit., p.304.
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