Have Leprosy, Will Travel: A Case of Early Modern Medical Tourism

On the tropical beach of a remote island, a group of ailing Europeans was spread across the white sands. Some lay soaking in medicinal baths assisted by local attendants; others dined on a special healing diet prepared from rare, locally-sourced ingredients. These exclusive treatments were not available in Europe, and sufferers were willing to pay an exorbitant amount to travel nearly three thousand miles to this far-flung location for the possibility of a cure.

So observed Christopher Columbus on his third voyage to the Americas in 1498. During a brief stop in Cabo Verde, a Portuguese-controlled archipelago off the Senegalese coast, Columbus saw European leprosy sufferers gathered on the island of Maio to be “fed on a diet of turtle meat and washed in turtle blood,” by which they were “speedily cured of their leprosy.”^[1] The notion that exotic substances could help cure the most incurable of diseases is nothing new to historians of medieval leprosy (a disease category that overlapped with, but was not identical to, the modern biomedical definition of leprosy or Hansen’s disease), but the fifteenth and sixteenth centuries mark a shift: not only did medicinal substances from far off places reach European markets in unprecedented quantities, but people were traveling significant distances in search of new remedies – what might be considered a form of medical tourism.^[2]

In fact, with a few notable alterations, the scene Columbus narrates wouldn’t be out of place in today’s health, wellness, and medical tourism industry. While medical tourism is often considered a way to save money on expensive treatments, some patients are willing to pay a premium to access medical care that is unavailable in their home country or state. Think women in the US traveling across state lines for legal abortion services or international COVID-19 vaccine tourism. Similarly, early modern accounts suggest that a select group of leprosy sufferers traveled great distances of their own volition (and on their own dime) for treatment.

These early modern medical tourists don’t fit with what we think we know about the history of leprosy. The idea of leprous travelers probably conjures images of nineteenth- and twentieth-century leprosy sufferers quarantined in remote imperial “leper colonies,” like the Kalawao leper settlement on the Hawaiian island of Molokai. Or perhaps an image of the medieval mendicant leper appears instead, equipped with a clapper and alms bowl. In both cases, travel was often involuntary. Many imperial states forcibly relocated individuals diagnosed with leprosy, supposedly to protect the healthy population (see, for example, the case of Anacleto Palabay). While mendicant lepers could move with comparative freedom in the medieval period, the extent to which this mobility was a choice rather than a necessity is questionable: once diagnosed, a leprosy sufferer was considered legally “dead” and thus barred from forming marriage contracts, holding office, or possessing property. This deprived most leprosy sufferers of a means to support themselves. Those lucky enough to enter leprosaria – hospitals modeled on monastic orders to provide lepers with material and spiritual care – renounced significant personal freedoms, including freedom of movement.^[3] Less fortunate leprosy sufferers were often left with few options but to beg.^[4]

What set apart those early modern leprosy sufferers who made the nearly three-thousand-mile journey from Lisbon to Cabo Verde from the examples above? They were, almost without exception, wealthy and elite. Franciscan cosmographer André Thevet, for example, described one such leprous traveler as a “gentleman from Portugal,” who outfitted his own ship to Cabo Verde. The unnamed gentleman “hired the best possible crew and procured livestock” to prepare for his journey.^[5] The cost of leasing, outfitting, supplying, and manning a ship from Europe to the Cabo Verde islands would have been an expensive endeavor, particularly if the intended voyage did not involve commercial exchange to offset costs.^[6] This kind of expedition would only be available to the extremely rich and well-connected, which perhaps explains why other famous recipients of Cabo Verdean sea turtle treatments include a Burgundian nobleman and King Louis XI of France.^[7] To these super-wealthy and influential leprosy sufferers, the chance to be cured was well worth the high cost and risks of a voyage to the islands – and not without reason.

By the mid-fifteenth century, most treatments for leprosy available in Europe were considered palliative rather than curative, leading sufferers to turn to more exotic, exclusive, and expensive medicinal substances, like Cabo Verdean sea turtles.^[8] Early voyagers to Cabo Verde appear to have been introduced to the culinary and curative properties of these sea turtles by West African sailors who had been recruited to help European ships navigate the coastline.^[9] It was also Africans, many likely enslaved, who later provided the necessary healing labor to care for leprous European visitors. According to Eustache de la Fosse, a Flemish merchant who visited Cabo Verde in 1483, Africans brought to the islands from the mainland would catch sea turtles, slaughter them, and bathe European leprosy sufferers in the turtle’s blood. “Once the blood is dry,” he explained, “[the leprosy sufferers] are so benumbed that they must be fed by hand like nestlings for two or three days; after, they are very well and feel great relief.”^[10] In addition to medicinal baths, other observers claimed that lepers were fed a therapeutic diet of sea turtle flesh and eggs.^[11] The reasoning behind sea turtle treatments didn’t concern most of these travelers, but it seems possible that such treatments drew on pre-existing African healing practices.^[12] Unsurprisingly, none of the accounts mention whether African healers and bodyworkers received any payment for their time-consuming and intimate work. Then, as now, the bodily care of wealthy foreigners often depended on local labor and expertise that was poorly compensated, if at all.

Cabo Verde’s fame as a destination for medical tourism lasted less than fifty years. With the rise of the Atlantic slave trade, Cabo Verde quickly grew to become an important entrepôt for the sale and export of enslaved people from West Africa to Europe and the Americas. By the mid-1520s, the African and mestiço population of Cabo Verde outnumbered European inhabitants by more than eight to one.^[13] The drastic shift in demographics and social dynamics profoundly affected European perceptions of the islands and their therapeutic reputation. Valentim Fernandes, a Moravian-born Portuguese printer who visited Cabo Verde in 1507, suggested that the influx of enslaved Africans had contaminated the environment. “These islands were so healthy at first that lepers who went there were healed, but now they are so unhealthy that even men in good health fall ill,” he lamented. “I believe it is because the blacks [negros] who have come there have poisoned the air.”^[14] European fear of pathogenic African bodies was a common trope of the Atlantic slave trade. Still, there is a particular irony to the fact that enslaved West Africans – the very source of the knowledge and labor that had made Cabo Verde a therapeutic destination in the first place – were now being blamed for, as Fernandes put it, “poison[ing] the air.”

At the same time, changing European views of the islands may reflect some degree of actual ecological change. As sea travel to Cabo Verde increased, native animal populations were displaced in favor of domesticated cattle, in particular goats, to provide salt meat for passing ships. Sea turtles were particularly susceptible to the heavy marine traffic that disturbed nearby reefs and nesting areas on beaches. Some native animals, including fish, large seabirds, and sea turtles, were also heavily hunted for their meat, shells, and eggs.^[15] The impact on the Cabo Verdean landscape would have been dramatic, amounting to what some scholars of environmental history have termed “ecocide.”^[16] Where early travelers had observed an archipelago of forested islands supporting diverse animal life, sixty years later they were instead greeted by empty beaches and arid, denuded hills.

European fears over the influx of supposedly-pestilential enslaved peoples coupled with ecological damage caused by increased traffic to the island seem to have spelled Cabo Verde’s demise as a medical tourism destination. By the mid-sixteenth century, Cabo Verde islands were better known for their “unhealthy and pestilential airs,” which caused “great fevers and hot ailments to those who remain there,” than they were for the treatment of leprosy.^[17] There is even some evidence that a leprosarium for indigent sufferers may have existed on Cabo Verde by the 1530s, bringing the islands full circle from a destination for the healing of wealthy medical tourists to one for the ailing poor.^[18]

Five centuries have passed since the rise and fall of leprous medical tourism to Cabo Verde. Even so, this unusual case reveals something troubling about medical tourism today. In the fifteenth century, Cabo Verdean sea turtle therapy was available exclusively to those with the social, legal, and financial resources to circumvent the stigma of a leprosy diagnosis and fund their passage to the islands. Medical tourism today is lauded as cost-saving and efficient, but it has the potential to create or exacerbate a two-tier system of healthcare in both tourism destinations and places of origin. As we are already seeing with the overturn of Roe v. Wade, the wealthy can often find ways to overcome social stigma and even legal hurdles to access the healthcare they need, whether at home or abroad. It is those already at the margins of society, whether due to poverty or minority status, who suffer most from restrictive health policies.

Anna Weerasinghe

Anna Weerasinghe earned her PhD from Johns Hopkins University in 2022. Her dissertation, "Stuck Knowledge: Medicine and Immobility in Portuguese Goa, 1500–1750," investigates how the patterns through which colonial medical knowledge traveled – or did not travel – were structured by gender, ethnicity, social status, and religion. She currently works in healthcare communications in Washington, DC.

• Anna Weerasinghe

  https://nursingclio.org/author/anna-weerasinghe/

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• Anna Weerasinghe

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