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

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.

On the right hand side the ten lepers approach Christ and the apostles
Christ heals 10 people with leprosy. (Wellcome Collection)

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.

Notes

  1. Bartolomé de las Casas, Las Casas On Columbus: The Third Voyage, ed. Geoffrey Symcox and Jesús Carrillo, trans. Michael Hammer and Blair Sullivan (Turnhout: Brepols, 2001), 23. This account comes from Las Casas’s monumental Historia de las Indias (1527-1561), which contains the earliest extant account of Columbus’s third voyage. Las Casas likely relied on Columbus’ own writings about the voyage, which have not survived. For commentary on the sources of Las Casas’s text, see Geoffrey Symcox, “Historical Introduction,” in Las Casas On Columbus, 5-6.
  2. Luke Demaitre, Leprosy in Premodern Medicine: A Malady of the Whole Body (Baltimore: Johns Hopkins Press, 2007), 248-270; Carole Rawcliffe, Leprosy in Medieval England (Woodbridge: Boydell, 2006), chapter 5.
  3. Carole Rawcliffe, Leprosy in Medieval England (Woodbridge: Boydell, 2006), 43.
  4. Even mendicant lepers were typically confined to designated urban areas where they could legally seek alms. In Portugal, for example, D. Pedro I (r. 1357-1367) granted mendicant lepers the right to beg, but only in certain cities. Such measures fit into a broader pattern of late medieval and early modern legislation that increasingly sought to police certain categories of mobile persons believed to pose a social threat, such as vagrants. See Robert Jütte, Poverty and deviance in early modern Europe (Cambridge: Cambridge Univ. Press, 1994); and Laurinda Abreu, The Political and Social Dynamics of Poverty, Poor Relief and Health Care in Early-Modern Portugal (London: Taylor and Francis, 2016), 15-21.
  5. André Thevet, “Cap. XIV. Des tortues, et d’une herbe qu’ils appellant Orseille,” in Les singularitez de la France antarctique autrement nommee Amerique, & de plusieurs terres et isles decouvertes de nostre temps (Paris, 1557), 63-69.
  6. M.M. F. Torrão, “Rotas Comerciais, Agentes Económicos, Meios de Pagamento,” in L. Albuquerque and M. E. M. Santos (eds.), História Geral de Cabo Verde, vol. II (Lisbon: IICT, 1991), 117-123.
  7. Eustache de la Fosse, “L’Île des Lépreux” in Voyage d’Eustache Delafosse sur la côte de Guinée, au Portugal et en Espagne: 1479-1481, ed. Théodore Monod (Paris: Editions Chandeigne, 1992), 41-45; Thevet, “Cap. XIV. Des tortues,” 63-69. Louis XI commissioned two ships to make the journey to Cabo Verde to procure the healing turtle blood for his use back in France. The ultimate outcome of the voyage, if it came to fruition, is unknown, as Louis XI died three weeks before the ships left port. It is possible that the voyage was abandoned when his son, Charles VIII, took the throne in August of 1483. Pierre Champion, Louis XI, vol. II, (Paris, 1927-28), 352-53.
  8. Luke Demaitre, “The Relevance of Futility: Jordanus de Turre (fl. 1313–1335) on the Treatment of Leprosy,” Bulletin of the History of Medicine 70, no. 1 (1996): 25-61.
  9. It was common practice in the early modern period for passing ships to hire local pilots short-term to help navigate particularly challenging coastal areas and ports. See references to these crew members hunting and cooking sea turtles aboard ship in Cà da Mosto, “The Voyages of Cadamosto,” in The Voyages of Cadamosto and Other Documents on Western Africa in the Second Half of the Fifteenth Century, ed. G.R. Crone (Farnham: Routledge, 2011), 64-65; and Fosse, “L’Île des Lépreux,” 41-45.
  10. “Une fois le sang asséché, elles se trouvent pendant deux ou trois jours se engourdies qu’il faut les nourrir à la becquée comme des oiselets.” Fosse, “L’Île des Lépreux,” 44-45.
  11. Las Casas, Las Casas On Columbus, 23; and Thevet, “Cap. XIV. Des tortues,” 66-67.
  12. Research by conservationists and anthropologists has shown that preparations of sea turtle flesh, blood, fat, organs, and bones are used as traditional medicine along the Senegal and Guinea coasts. See, for example, J. Fretey, G.H. Segniagbeto, and M. Soumah, “Présence des tortues marines dans la pharmacopée traditionnelle et les croyances en Afrique Occidentale,” Proceed. IIe Congrès Conserv. 4, (Dakar, 2006): 204-207 (republished in translation as: “Presence of Sea Turtles in Traditional Pharmacopeia and Beliefs of West Africa,” Marine Turtle Newsletter 116 (2007): 23-25). Historical studies of late sixteenth- and seventeenth-century Inquisition cases and Jesuit correspondence similarly reveal that zootherapy was widely practiced on Cabo Verde (to the great alarm of religious authorities), although these accounts do not specifically address the use of sea turtles. Philip J. Havik, “Hybridising Medicine: Illness, Healing and the Dynamics of Reciprocal Exchange on the Upper Guinea Coast (West Africa),” Med. Hist. 60, no. 2 (2016): 181–205; Timothy Insoll, “Shrines, substances and medicine in sub-Saharan Africa: archaeological, anthropological, and historical perspectives,” Anthro. & Med. 18, no. 2 (2011): 145-166.
  13. T. Bentley Duncan, Atlantic Islands: Madeira, The Azores, and the Cape Verdes in seventeenth-century commerce and navigation (Chicago: University of Chicago Press, 1972), 206-207; see also Table 30 on 210.
  14. “Esta ylhas erã de primeyro tã sadias q quãtos gaffos alli vinhã sarauã. Mas agora sõ tã doẽtias q a gẽte saã adoeçe. Creo q despois q os Negros trousserõ a ellas corrõperõ ho aar como ẽ sua terra he doẽtia.” Valentim Fernandes, Description de la Côte Occidentale d’Afrique (Sénégal au Cap de Monte, Archipels), eds. T. Monod, A. Teixeira da Mota, and R. Mauny (Bissau, 1951), 110 [f. 184r].
  15. Cristina Brito and Nina Vieira, “A Sea-Change in the Sea? Perceptions and Practices Towards Sea Turtles and Manatees in Portugal’s Atlantic Ocean Legacy,” in Perspectives on Oceans Past (Dordrecht: Springer, 2016), 175-191; N.S. Loureiro and M.M.F. Torrão, “Homens e tartarugas marinhas: Seis séculos de história e histórias nas ilhas de Cabo Verde,” Anais de História de Além-Mar 9 (2008): 37–78.
  16. Per A. Lindskog and Benoît Delaite, “Degrading Land: An Environmental History Perspective of the Cape Verde Islands,” Environ. and Hist. 2, no. 3 (1996): 271-90; and Stefan Halikowski Smith, “The mid-Atlantic islands: A theatre of early modern ecocide?” Internat. Rev. Soc. Hist 55, no. S18 (2010): 51-77.
  17. “L’air y est mal sain & pestilentieux, causant de grande fiebures & chauds maux à ceux qui s’y arrestent.” Thevet, “Cap. XIV. Des tortues,” 69.
  18. Royal charters dating to 1531 and 1597 appointed a “caretaker of orphans, chapels, monasteries and leprosaria [gafarias]” on the island of Santiago. Henrique Lubrano de Santa-Rita Vieira, História da medicina em Cabo Verde (Praia: Instituto Caboverdiano do Livro e do Disco, 1987), 23. An actual structure to house leprosy sufferers dates from the mid-eighteenth century. A. Loretti and D. Garbellini, “Leprosy in the Cape Verde Islands,” Leprosy Rev. 52, no. 3 (1981): 337-348, esp. 338.

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.

1 thought on “Have Leprosy, Will Travel: A Case of Early Modern Medical Tourism

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      Fascinating piece, and the parallels drawn feel really important to me — thank you! (Small correction: The caption for the Christ art should say cures, not kills.)

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