142 • Pia Bennike 



If we look at the epidemiological aspect of the past, studies 

 of this kind already began in Denmark with the previously 

 mentioned work on Norsemen by Hansen ( 1924), but it was 

 soon followed in 1936 by a study of 400 medieval skeletons 

 excavated at 0m monastery (Isager 1936). Isager, who exam- 

 ined the bones, had a medical background as a general practi- 

 tioner and was naturally most interested in describing the 

 unusual pathological finds. Without having contemporary 

 material for comparison his study was mainly a description of 

 the pathological appearance of single bones. He also counted 

 the number of bones with different kinds of defects, for ex- 

 ample bones with evidence of healed fracture. However he 

 did not count the number of normal bones, so no frequencies 

 of the pathological changes in this material are known. Epi- 

 demiologically the study is therefore of limited value, but 

 contrary to Hansen, Isager was aware of not going to ex- 

 tremes in his interpretation of the results before he had com- 

 parative material. 



In the following decades the works of M0ller-Christensen 

 totally dominated the field of paleopathology in Denmark 

 (1953, 1958. 1961, 1963, 1967, 1978). Moller-Christensen 

 started his activity in 1935 by excavating more than 700 

 medieval skeletons at /Ebelholt monastery on Zealand 

 (M0ller-Christensen 1958). He mainly studied the many 

 pathological changes, which resulted in an excellent and use- 

 ful publication, which unfortunately to date has been pub- 

 lished only in Danish. The book contains tables with frequen- 

 cies of almost all kinds of pathological changes seen in the 

 medieval skeletons, and the results can therefore be com- 

 pared to all later results of paleopathological studies. This 

 makes the book on the skeletons from yCbeiholt monastery 

 much more useful than the one based on the skeletons from 

 0m monastery. It is also interesting to see the difference in 

 the number of diagnoses mentioned in the two studies by 

 IsagerandM0ller-Christensen. The number of different diag- 

 noses is quite small in the book by Isager, while M0ller- 

 Christensen mentions more than three times as many. This 

 may primarily be owing to the different years in which the 

 studies were carried out and to new methods developed dur- 

 ing the second half of this century, which allowed more 

 precise diagnoses to be made and described. 



After M0ller-Christensen finished his study on diseases in 

 the Middle Ages based on the many skeletons from /Ebelholt 

 monastery, he carefully planned his next study. One of the 

 /Ebelholt skeletons had shown some changes that might have 

 been caused by leprosy. During his search for comparable 

 bones affected with leprosy he realized that very little was 

 known of skeletal changes due to this disease. He therefore 

 decided to elucidate this topic. From historical records it was 

 known that the so-called St. George houses were scattered 

 throughout Denmark during the Middle Ages. People af- 

 fected with leprosy were forced to live there for the rest of 

 their lives, separated from their friends and families. M0ller- 

 Christensen succeeded in locating the place where one of 

 these houses and the surrounding graves were situated. 



After acquiring permission to start excavating the graves in 

 1941 , more than 200 skeletons were recovered. This material 

 made it possible for the first time to study changes in bone 

 due to leprosy on the basis of several hundred skeletons 

 affected with the disease. This was indeed a collection of 

 high value for paleopathological studies (M0ller-Christensen 

 1961,1967,1978). M0ller-Christensen's exceptional study 

 made it possible to add new points to the clinical diagnosis of 

 leprosy. The typical changes of the maxilla and of the nasal 

 aperture with the loss of the nasal spine had not been de- 

 scribed in skeletons before. His studies may also in an inter- 

 national sense be labeled as unique. Often our studies in 

 paleopathology are restricted by a small sample size or mate- 

 rial somehow selected to produce underrepresentation of cer- 

 tain age or sex groups. In such cases its epidemiological 

 value may be questioned. Sample size was not the problem in 

 M0ller-Christensen's material from the leprosarium. The 

 skeletons excavated at Nsestved are naturally not representa- 

 tive for the average medieval population, but together they 

 form an interesting group consisting of those who were ex- 

 pelled from the normal community because of a specific 

 disease. The study of this group was the aim of M0ller- 

 Christensen's work. 



In recent years a new group of skeletons of several hundred 

 individuals from almost the same area and period has been 

 excavated. Future detailed studies will show whether the 

 medieval people from Nasstved really managed to diagnose 

 and expel all those affected with leprosy. M0ller-Christensen 

 found that about 80% of the skeletons from the leprosarium 

 showed some of the characteristic changes in bone due to 

 leprosy, whereas this author, in a preliminary study of the 

 skeletons from a common cemetery within the town, did not 

 find any changes due to leprosy in the skeletons. 



Today, when Acquired Immunodeficiency Syndrome 

 (AIDS) seems to threaten the modem world's population and 

 the discussions of how to prevent and restrict contamination 

 are varied and often heated, it is interesting to go back 600- 

 700 years to see what happened in a somewhat similar situa- 

 tion. At that time people who were suspected of having lep- 

 rosy were doomed to spend the rest of their lives isolated in 

 the St. George houses, and it is the remains of those people 

 we are able to study today. Today leprosy is almost extinct in 

 the West, but is still known in many developing countries. 



From modem studies we now know that leprosy is not 

 highly infectious, and it is not necessary to force the affected 

 people to live their whole lives isolated and expelled from the 

 community; they can lead a normal life (Kom 1982). The best 

 way to prevent the disease is to provide better living condi- 

 tions. In a very poor area in Norway the disease disappeared 

 only in the beginning of this century. The medieval people at 

 the leprosarium seem to have suffered not only from the 

 disease but also from condemnation by healthy people who 

 wanted to protect themselves. Let us not repeat this mistake 

 by isolating those affected with AIDS. In this case the bones 

 of the dead may teach the living what should NOT be done. 



Zagreb Paleopathology Symp. 1988 



