A scapula deformity in two burials from medieval England

A scapula malformation is described in two burials from the site of the late medieval Dominican friary at Ipswich, UK. The changes appear most consistent with primary scapular neck dysplasia. One of the burials also showed clear signs of leprosy. The burials are of lay benefactors of the friary. The Ipswich Dominican friary had no known function as a leprosy hospital. Finding of burials of lepers other than in burial grounds of leprosaria is highly unusual for medieval England. Scapular neck dysplasia has a strong genetic component in its aetiology. This, coupled with its rarity, suggests a close genetic link between the two burials. The findings suggest that in this case, family ties with the friary overrode the normal medieval custom of interring lepers in leprosy hospitals. This illustrates that even rare skeletal variants may convey useful biocultural information about past populations. Copyright © 2008 John Wiley & Sons, Ltd.     

The treatment of leprosy in 19th‐century London: a case study from St Marylebone cemetery

A young adult male, context [825], exhibiting a suite of proliferative and erosive skeletal changes, was excavated from the old burial ground of St Marylebone, London, in 2005 by the Museum of London Archaeology Service (MoLAS). Although pathognomonic rhinomaxillary changes were absent, a number of lesions were of a type previously recorded in individuals suffering from lepromatous leprosy, including resorption of the alveolar process of the maxillae and the digits of the right hand, osteomyelitis in the left ulna and collapse of the left ankle. Whilst this infectious disease was widespread in medieval Britain, it had declined by the 19th century, and has been identified in only one other post‐medieval archaeological context. The right leg of [825] had been surgically amputated. This form of intervention was a recognised treatment for the complications of the disease, where neuropathic damage of limbs led to life‐threatening infection. The healing of the amputation demonstrates the success of the operation, and the skill of the surgeon. Although the identity of the affected individual is unknown, burial within St Marylebone cemetery implies a level of status not frequently associated with leprosy sufferers in the past. Copyright © 2008 John Wiley & Sons, Ltd.     

A case study of possible differential diagnoses of a medieval skeleton from Denmark: leprosy,ergotism, treponematosis,sarcoidosis or smallpox?

This paper uses macroscopic and radiological examinations to provide differential diagnoses of pathological lesions in the skeleton of a young woman, 20–25 years of age, which triggered the Danish palaeopathologist Vilhelm Møller‐Christensen's interest in leprosy. The skeleton was incomplete, but the majority of bones of the upper body, as well as the skull, were present. The pathological changes consisted of medullary and cortical lytic foci, periosteal reaction and enhanced cortical density. The lesions were most extensive on the left side, especially around the elbow, wrist and scapula. Treponematosis, leprosy, smallpox, ergotism, rheumatoid arthritis, tuberculosis and sarcoidosis are all reviewed with regard to bone and joint pathology and their likelihood of being the correct diagnosis. We concluded that the most plausible diagnosis is treponematosis, but neither sarcoidosis nor smallpox can be completely excluded. Copyright © 2007 John Wiley & Sons, Ltd.     

Probable early presence of leprosy in Europe in a Celtic skeleton of the 4th–3rd century BC (Casalecchio di Reno,Bologna, Italy)

Examination of the skeleton of an adult male from the Celtic necropolis of Casalecchio di Reno (Bologna, Italy; 4th–3rd century BC) revealed some lesions on the feet, especially bilateral acro‐osteolysis of the metatarsals, and on the tibia, fibula and hand. The morphological and radiographic characteristics of the bones are consistent with a diagnosis of leprosy. Other features of the rhinomaxillary region support this diagnosis. As far as we know, this case could represent the oldest skeletal evidence of leprosy in Europe, indicating the early spread of this disease toward the Western world. Copyright © 2005 John Wiley & Sons, Ltd.     

Leprosy in a skeleton from the 7th century necropolis of Vicenne‐Campochiaro (Molise,Italy)

Analysis of the skeleton from tomb 144 of the early medieval necropolis of Vicenne‐Campochiaro in Central Italy revealed several features indicative of leprosy. The skeleton belongs to a male estimated to be between 20 and 25 years of age at death. The distal halves of the 1st and 2nd left metatarsals present acro‐osteolysis and both legs show severe subperiosteal bone reaction. The facial skeleton shows changes compatible with a chronic inflammatory process, possibly due to an infectious disease. The anatomical distribution of the lesions and their association with other skeletal lesions seems to be compatible with a near‐lepromatous form of leprosy. A differential diagnosis is made, and the skeletal traits pathognomonic of leprosy are discussed. Copyright © 2005 John Wiley & Sons, Ltd.     

‘No more road to walk’: cultures of heritage and leprosariums in Singapore and Malaysia

This paper examines how the state, social activists and former sufferers of leprosy participate in an international heritage discourse and how they construct the history of leprosy in contemporary Singapore and Malaysia. This paper finds both dissonances but also convergences between these different interests. The emergence of such entangled narratives is taking place at a time when the leprosariums are threatened by redevelopment and while social activists are calling for their conservation as heritage sites. The paper finds that both the state and social activists, in different ways, have selectively appropriated the history of leprosy to fit an international heritage discourse. Meanwhile aspects of that history, which are deemed incompatible, are discarded to fall in between the cracks of the discourse. By contrast, the oral history accounts of the leprosariums’ residents, as a possible source for intangible and radical heritage, are ambivalent about the sites’ heritage values. They reveal that while many residents reject the heritage discourse that seeks to save their homes from demolition, others have created a unique culture of heritage that appropriates the international discourse, but also expresses their own needs and perspectives. Cultures of heritage are, however, themselves fluid and liable to change like the memories on which they are based.     

Leprosy at the Lazaretto on St Eustatius,Netherlands Antilles

Leprosaria established in the Americas during the Colonial period bear many similarities with those found in medieval Europe. They are comparable in terms of isolation, the objectification of leprosy sufferers and their association with religious charities. The Lazaretto on St Eustatius was operated from 1866 to 1923. The site was investigated to recover palaeopathological evidence of leprosy at a leprosarium in the Americas. Five burials were excavated; three individuals showed evidence of bone modifications consistent with those caused by leprosy, including aspects of ‘rhinomaxillary syndrome’ and the bilaterally symmetrical post‐cranial changes that have been described in leprosy examples from medieval Europe. An exceptional find was the presence of potentially leprous bone changes to the hyoid, thyroid and 3^rd–6^th cervical vertebrae. Copyright © 2007 John Wiley & Sons, Ltd.     

Health status of the Venda,a post‐antibiotic community in rural South Africa

This paper examines the health status of a rural African community during the emergence of Westernisation. A total of 157 skeletons, which included 120 adults (55 males and 51 females), 37 juveniles, and 14 individuals of unknown age, were analysed. Date of death ranged from 1910 to 1999, with the majority of individuals (52%) being buried after 1960. The bones were examined for infectious diseases, trauma and degenerative changes. More than half of the individuals in the sample had no pathological lesions on their skeletal remains. No cribra orbitalia was present. One case of leprosy and three cases of osteomyelitis were recorded. The most common findings were osteophytes on the vertebral bodies (syndesmophytes) (17%) and osteoarthritis (7%). The low occurrence of chronic disease is unexpected given that malaria was endemic and intestinal worms were common. Explanations for these results include adequate intake of iron from dietary sources, death from acute infectious diseases, administration of antibiotics, and poor preservation of adult skeletal remains. Copyright © 2007 John Wiley & Sons, Ltd.     

Metastatic carcinoma in a leper skeleton from a Medieval cemetery in Chichester England

Both leprosy and metastatic cancer are well documented in the literature on human skeletal palaeopathology. The manifestation of both pathological conditions in a single archaeological skeleton has not been reported. A case from a Medieval site in Chichester, England exhibits bone lesions and patterns of skeletal involvement indicative of both these diseases. Evidence of leprosy is largely restricted to the lower tibiae, fibulae and the bones of the feet. Fine destructive foci and reactive fibre bone associated with metastatic cancer are distributed in many of the remaining areas of the skeleton. There is minimal overlap in the areas of the skeleton involved in the two pathological processes.     

Paleopathological and Molecular Study on Two Cases of Ancient Childhood Leprosy from the Roman and Byzantine Empires

This study is based on the paleaopathology of leprosy on human skeletal remains and the detection of ancient Mycobacterium leprae DNA. Two cases of childhood leprosy were recognized. The first case was in a Roman necropolis at Martellona (Rome, Central Italy), dated to the 2nd to 3rd centuries ce . The skeleton of a child aged 4–5 years, from tomb 162, is the youngest individual in Italy from this time period, with the clear rhino‐maxillary syndrome and other bony changes indicative of leprosy. The second case from a burial at Kovuklukaya, in the Sinop region of Northern Turkey, was from the 8th to the 10th centuries, during the Byzantine era. The endocranium of a 4–5‐month‐old infant with new bone formation—an indication of chronic inflammation—was positive for M. leprae DNA. Infant and childhood leprosy is uncommon today, and there is a scarcity of information in the osteoarchaeological literature of leprosy in the past, especially in children. The significance of these cases is that it adds to an understanding of the history of the disease in the former Roman Empire. It is hoped that over time sufficient data can be obtained to understand the epidemiological dynamics and clinical evolution of leprosy from the ancient period until today. Copyright © 2012 John Wiley & Sons, Ltd.