Lepro-C: Defining the Macroscopic Assessment of Leprosy Using the Evidence of Child and Adult Skeletal Remains

This project explored the nuance and variability of macroscopic skeletal manifestations of leprosy in 252 individuals from two leprosarium cemeteries from late medieval England. Modern clinical literature and translated medieval Latin medical texts were used to assess how leprosy was being diagnosed at the time, and how that compares with modern-day leprosy.

The aims of this research were to develop a new method to assess leprosy in skeletal remains, called Lepro-C, to increase diagnostic rigour in palaeopathology; assess the nuance and variability of leprosy in skeletal remains with reference to recent clinical research, including identifying previously unexplored lesions in skeletal individuals of adult ages. It also aimed to reassess the diagnostic capabilities of medieval physicians by directly engaging with the medieval medical texts of Constantine the African and John de Gaddesden.

The main conclusions from this research are that Lepro-C shows promise as a replicable and rigorous approach to assessing leprosy in skeletal remains; previously unexplored lesions for leprosy in bioarchaeology show encouraging links to leprosy; adults aged 26-35 years were most likely to die displaying the most distinctive signs of leprosy; and absorptive rhinomaxillary lesions are morphologically variable. It also showed that distinctive macroscopic combinations of leprosy lesions occur in non-adults older than 10 years, but other criteria are required for individuals younger than this in future research. This research also showed that Medieval physicians had a solid grasp on the variable manifestation of leprosy in affected individuals, noting symptoms comparable to that of modern clinical leprosy.

Lepro-C provides a way forward to improve our knowledge of the variable expression of leprosy in skeletal material, to increase the soundness of the contribution that palaeopathology can make to the wider discussion of leprosy, past and present, via consistent and replicable assessment. The medieval Latin texts also demonstrate the value of actively implementing a multidisciplinary approach to research by using primary historical resources to inform discussions.