30 • Keith Manchester 



LEPROSY 



The earliest evidence of leprosy is often quoted as facies 

 leontina represented by a Canaanite jar from Beth-Shan, Pal- 

 estine, dated to mid second millennium B.C. (Yoeli 1955). 

 However, this jar is not considered representative of leprosy 

 (Manchester and Zias, n.d.)but is, it is proposed, a portrayal 

 of negroid facial features. 



There is literary record, displaying obvious clinical acu- 

 men, of significant symptoms and signs of lepromatous lep- 

 rosy in Sushruta Samhita (Dharmendra 1947:425-429), 

 dated to 600 B.C. This, the earliest acceptably authentic evi- 

 dence, indicates that the disease existed in India by the mid 

 first millennium B.C. For a disease to have been so notewor- 

 thy to have been recorded in literature, it is likely, in antiq- 

 uity, that it was present in the community for some consider- 

 able time previous. Rastogi and Rastogi (1984:541) have 

 suggested that the word "kustha," mentioned in Indian litera- 

 ture in the 15th century B.C., denotes leprosy. However, this 

 reference is without clinical description and is based on im- 

 precise social attitudes toward a disease, the nature of which 

 is uncertain. It is not justifiable, therefore, to attribute M. 

 leprae infection to this reference. 



From the second century B.C. , a terra cotta figure has been 

 considered representative of leprosy (Grmek 1983:232). 

 Also of third century B.C. date, a Chinese Bamboo Book 

 contains a description of physical signs and symptoms which 

 are compatible with a diagnosis of leprosy (Skinsnes 1980). 



As yet , the earliest skeletal evidence of leprosy in the world 

 has been recorded from the Dakhleh Oasis, Egypt. Skeletons, 

 of reputed European morphological type, have been diag- 

 nosed as leprous on rhinomaxillary change (Dzierzykray- 

 Rogalski 1980). Professor Rogalski's suggestion is that these 

 skeletons, a minor component of a larger negroid nonleprous 

 cemetery, represent European individuals segregated from the 

 Greek colonial center because of their disease . If this sugges- 

 tion is valid, then such a policy of ostracism may indicate the 

 presence of leprosy in the Mediterranean littoral for many 

 years prior to the date of the cemetery at Dakhleh Oasis in the 

 second century B.C. This may be compatible with a new 

 disease appearing in Greece at about the third century b.c. and 

 described by Straton, a physician of the Alexandrian School. 

 Andersen (1969:45) suggests that leprosy may have been 

 brought to the Mediterranean area from India by the returning 

 armies of Alexander the Great, but this view is considered to 

 be, perhaps, too simplistic. Passage of peoples from the Far 

 East to the Near East was, surely, a phenomenon for many 

 years at that time, and it is not necessary to attribute the 

 transference of leprosy to such a precise event. 



Further evidence of leprosy has been recorded in two Cop- 

 tic mummies from Nubia. These specimens, dated to a.d. 

 500 exhibit peripheral skeletal and rhinomaxillary stigmata 

 pathognomonic of lepromatous leprosy (M0ller-Christensen 

 and Hughes 1966). 



From the seventh century a.d.. skeletons exhibiting 

 |X)stcranial and rhinomaxillary changes of leprosy have been 

 identified in the ossuaries of Byzantine period monasteries of 

 the Judcan Desert (Zias 1985). 



From northern Europe, the earliest evidence of leprosy is 

 discovered in skeletal remains from Poundbury, Dorset 

 (Reader 1974). The skeletal remains, dated to the fifth cen- 

 tury A.D. of late Romano-British context, consist of the lower 

 legs and feet only, the sole fragments archeologically avail- 

 able for study. Although the absence of upper limbs and 

 cranium for study reduces the validity of diagnosis, and 

 doubt has been cast on this (T. Molleson, pers. comm. 1987), 

 it is considered that, in differential diagnosis, leprosy is the 

 most likely. 



During succeeding centuries leprosy became widespread 

 and of increasing prevalence throughout northern Europe and 

 lands of the Mediterranean littoral, as attested by art form, 

 literary, and skeletal evidence (Andersen 1969; Gladykow- 

 ska-Rzeczycka 1976; Grmek 1983:227-260; Manchester 

 1981; Manchester and Roberts 1987; M0ller-Christensen 

 1967; Skinsnes 1972; Wells 1962,1967). 



As in the discussion of the history of tuberculosis , it is only 

 necessary, for this paper, to discuss in more detail the history 

 of leprosy in Britain. 



Although the skeletal evidence of leprosy in post-Norman 

 Conquest Britain is less profuse than in contemporaneous 

 Scandinavia, a reflection of the research of Professor M0ller- 

 Christensen, the overall development and change, temporal 

 and geographic, of leprosaria in medieval England is as well 

 known as in any other European country. As has been dis- 

 cussed, the history of tuberculosis is also as well known 

 in the period of disease contemporaneity as in any other 

 country. 



Unlike the study of other diseases, and unlike the study of 

 leprosy in earlier centuries, the prevalence and change there- 

 in of leprosy in post-Norman Conquest Britain cannot be 

 assessed from the isolated study of osteoarcheological re- 

 mains. This is because segregation of leprosy sufferers in this 

 period was certainly general, although not exclusive, policy. 

 Leprous skeletons are found therefore in the cemeteries of 

 leprosaria and less so in the cemeteries of nonlazar houses, 

 monastic communities, and parish churches (Manchester and 

 Roberts 1987). Thus, a diminishing number of leprous skel- 

 etons in nonlazar house cemeteries after the Norman Con- 

 quest must not be taken as indicative of a decline in the 

 prevalence of the disease at this time. An assessment of 

 leprosy prevalence and incidence can only be made by com- 

 posite study of skeletal remains, lazar house foundations and 

 development, lazar house records, and legal enactments. 

 Such a multidisciplinary study is, at present, only in its in- 

 fancy. 



A gross numerical analysis, century by century, of record- 

 ed leprosaria in Britain shows a marked increase in their 

 number during the period from the 11th to 13th centuries 

 (Roberts 1986). In broad terms, the trend demonstrated by 



Zagreb Paleiipathology Symp I98fi 



