Following Stigma and Segregation of Individuals Afflicted with Lepromatous Leprosy

14 Pages·2016·0.19 MB·English

by  Deanna Bogaski

Following Stigma and Segregation of Individuals Afflicted with
Lepromatous Leprosy

Deanna
 Bogaski

University
 of
 Manitoba

Key
 Words:
 burial
 practices;
 segregation;
 stigma;
 multibacillary
 leprosy;
 isolation;

compassion;
 graves;
 leprosaria;
 Hansen’s
 disease;
 cross-­‐cultural
 compairison;

palaeopathology;
 osteology;
 endemic
 disease;
 germ
 theory;
 fear
 of
 infection

Abstract

Modern
 Western
 society
 tells
 a
 tale
 of
 fear
 and
 exclusion
 of
 individuals
 with
 leprosy
 on
 a

global
  scale,
  yet
  case
  studies
  from
  across
  the
  globe
  tell
  a
  tale
  of
  compassion,
  not
  of

stigmatization.
 The
 effects
 of
 leprosy
 can
 be
 crippling
 and
 cause
 disfigurement,
 and
 many

cultures
 had
 their
 own
 beliefs
 associated
 with
 the
 disease.
 In
 the
 19th
 century
 a
 rise
 in
 the

prevalence
 of
 leprosy
 incited
 fear
 in
 the
 population
 and
 historical
 methods
 of
 treatment

were
 sought,
 namely
 Leprosaria.
 In
 this
 case
 fear
 of
 contracting
 this
 disfiguring
 disease

cultivated
 a
 repulsion
 from
 those
 affected.
 Originally,
 Leprosaria
 were
 founded
 because
 it

was
 believed
 that
 those
 who
 had
 contracted
 the
 disease
 had
 sinned,
 and
 through
 living
 a
 life

of
 piety
 would
 be
 redeemed.
 Modern
 Western
 society
 believed
 that
 this
 had
 inadvertently

helped
  to
  isolate
  the
  contagious
  disease.
  The
  model
  was
  mimicked
  but
  isolation
  and

segregation
 were
 forced,
 propagated
 by
 the
 idea
 that
 this
 was
 the
 method
 to
 which
 all

afflicted
 populations
 had
 eventually
 turned,
 finding
 no
 effective
 alternative.
 Archaeological

and
 ethnographic
 accounts
 from
 Japan,
 India,
 and
 Europe,
 demonstrate
 that
 in
 most
 cases,

segregation
 was
 not
 a
 method
 practiced,
 and
 when
 it
 occurred
 it
 was
 through
 individual

choice;
 many
 infected
 individuals
 chose
 to
 remain
 with
 their
 families
 and
 communities
 until

death.

the
  world
  and
  continues
  to
  persist
  in

Introduction

certain
  regions.
  My
  query
  is
  when
  the

Leprosy,
 now
 known
 as
 Hansen’s
 disease,
  stigma
  that
  is
  so
  commonly
  associated

is
 associated
 with
 social
 stigma,
 fear,
 and
  with
  lepers
  and
  leprosy
  in
  modern

hatred
  in
  both
  life
  and
  death.
  Visceral
  Western
  society
  (Europe
  and
  North

reactions
 occur
 to
 the
 disfigurement
 and
  America)
 originally
 arose.
 Is
 it
 possible
 to

effects
  of
  this
  disease
  and
  its
  slow
  and
  assess
 social
 marginalization
 or
 ostracism

prolonged
  progression.
  This
  is
  a
  disease
  through
  burials
  and
  archaeological

present
  in
  the
  Old
  World
  (Asia,
  Africa,
  remains?
  In
  many
  cases,
  what
  could
  be

and
  Europe)
  at
  least
  since
  the
  rise
  of
  perceived
  as
  evidence
  of
  discrimination

urbanization.
 It
 has
 spread
 to
 all
 parts
 of
UMASA
 Journal
 Vol
 33(2015)

could
 in
 fact
 be
 much
 more
 complex.
 The
  Tucker
 (2012),
 and
 Rawcliffe
 (2006),
 which

case
 of
 leprosy
 throughout
 human
 history
  revised
  the
  ideas
  on
  stigma
  associated

illustrates
 this
 very
 well,
 in
 finding
 both
  with
  medieval
  lepers.
  Further,
  research

normal
 and
 abnormal
 burial
 practices
 of
  conducted
  in
  other
  countries
  was
  often

individuals
 with
 the
 disease.
 Through
 an
  published
  in
  the
  national
  language,
  and

understanding
  of
  the
  diseases
  effects,
  has
 yet
 to
 be
 translated
 into
 English,
 such

archaeological
  findings,
  and
  the
  visible
  as
  further
  information
  on
  the
  peculiar

changes
 in
 perception
 it
 can
 be
 hoped
 to
  Nabe-­‐kaburi
  burials
  from
  Japan
  to
  be

gain
  a
  better
  understanding
  of
  the
  discussed
 later
 (Suzuki
 et
 al.
 2014).

opprobrium
  associated
  with
  the
  disease,

As
 well,
 the
 query
 in
 itself
 has
 limits

and
 of
 the
 human
 ability
 for
 compassion.

to
 what
 it
 can
 achieve.
 Today
 there
 are
 a

The
  first
  section
  will
  discuss
  multitude
  of
  feelings
  and
  attitudes

limitations,
  the
  second
  section
  will
  towards
 leprosy,
 individuals
 have
 different

introduce
  the
  bacterium
  that
  causes
  reactions
  and
  the
  same
  scope
  and

leprosy,
  and
  will
  be
  followed
  by
  complexity
  can
  be
  thought
  to
  have

terminology.
 The
 fourth
 section
 discusses
  occurred
  in
  the
  past.
  Attempting
  to

what
  social
  stigmatization
  of
  leprous
  understand
  the
  complexity
  of
  this
  issue

individuals
 was
 believed
 to
 look
 like.
 Then
  historically
  through
  an
  assemblage
  of

the
  pathologies
  found
  in
  archaeological
  archaeological
  sources
  and
  historical

remains
  of
  leprous
  individuals
  and
  references
 can
 only
 be
 reflective
 of
 a
 small

leprosy’s
  physical
  manifestations
  will
  be
  portion
  of
  the
  ideas
  and
  practices
  that

discussed,
  and
  how
  it
  has
  been
  occurred
  and
  are
  subject
  to
  individual

determined
  if
  an
  individual
  lived
  with
  interpretation.
  The
  archaeological
  data

leprosy.
  Then
  specific
  archaeological
  gathered
 cannot
 ascertain
 the
 nuances

examples
  from
  Western
  and
  Eastern
  of
  an
  individual’s
  everyday
  life.

contexts
  will
  be
  examined
  in
  order
  to
  Bioarchaeological
 examinations
 are
 largely

ascertain
  if
  the
  modern
  Western
  belief
  limited
  to
  qualitative
  data
  and
  cannot

that
  leprosy
  is
  a
  globally
  stigmatized
  produce
 verifiable
 qualitative
 data.

disease
  holds
  any
  truth.
  How
  these

For
 example
 in
 isotopic
 analysis
 diet

modern
 Western
 beliefs
 came
 to
 existence

can
 be
 ascertained,
 but
 not
 the
 quality
 and

will
 lead
 into
 the
 conclusion
 on
 whether

freshness
  of
  the
  food
  when
  consumed,

leprosy
  holds
  social
  stigma
  on
  a
  global

which
 could
 be
 affected
 by
 stigma;
 food

scale.

may
 have
 been
 given
 to
 individuals
 with

  leprosy
 only
 after
 it
 was
 no
 longer
 suitable

or
 desirable
 for
 others
 to
 eat
 (Linderholm

Limitations

and
 Kjellström
 2011).

 Further,
 the
 bones

A
 limitation
 that
 I
 faced
 in
 conducting
 this
  and
 burials
 themselves,
 while
 being
 a
 large

research
 was
 access
 to
 sources
 I
 wished
 to
  source
  of
  information,
  may
  also
  pose

consult.
 Some
 limitations
 were
 due
 to
 the
  many
  limitations.
  The
  osteological

limits
  of
  the
  University
  of
  Manitoba’s
  paradox
  comes
  to
  mind
  when
  assessing

library
 resources
 for
 undergraduates,
 such
  the
  apparently
  healthy
  skeletons
  from

as
 F.O.
 Touati’s
 influential
 works,
 cited
 in
  numerous
 leprosaria
 (Wood
 et
 al.
 1992).

the
  work
  of
  Brenner
  (2010),
  Roffey
  and
  Were
 a
 number
 of
 the
 individuals
 interred

Bogaski
  2
UMASA
 Journal
 Vol
 33(2015)

at
  the
  cemetery
  of
  the
  hospital
  at
  the
  speculated
  origin
  of
  M.
  leprae
  is

Chichester,
  England
  healthy
  as
  it
  would
  approximately
 40,000
 years
 ago
 (Robbins

appear
  from
  their
  bones
  (Lee
  and
  et
 al.
 2009:6).
 Skeletal
 manifestations
 of
 a

Magilton
 1989),
 or
 were
 they
 weak
 and
 the
  more
  ancient
  origin
  may
  be
  found
  in

disease
 caused
 their
 death
 so
 quickly
 that
  future
 excavations.

osteological
 changes
 did
 not
 have
 the
 time

The
 bacillus
 has
 a
 single
 clone
 origin,

necessary
  to
  occur?
  Empirical
  evidence

as
  suggested
  through
  analysis
  of
  the

from
 DNA
 analysis
 has
 proved
 useful
 in

genome
  which
  has
  observed
  nearly

positively
 identifying
 suspected
 victims
 of

identical
  strains
  in
  numerous
  location

Mycobacterium
 leprae
 (Suzuki
 et
 al.
 2010).

across
 the
 globe,
 although
 it
 was
 possible

However,
  to
  do
  such
  an
  analysis
  on
  all

to
 classify
 these
 into
 four
 types
 (Maiden

skeletal
 material
 would
 be
 costly,
 both
 in

2009,
 Suzuki
 et
 al.
 2010,
 Grimm
 2005).
 The

time
 and
 money,
 as
 well
 as
 destructive.

current
 theory,
 based
 on
 the
 large
 portion

Finally
 excavations
 of
 burial
 sites
 are
  of
  inactive
  genes
  in
  the
  chromosome
  of

often
  only
  partial
  excavations,
  and
  can
  the
 bacillus,
 is
 that
 M.
 leprae
 underwent

give
 only
 a
 glimpse
 into
 the
 data
 that
 may
  extreme
 evolutionary
 selection,
 and
 is
 the

be
  available;
  this
  could
  easily
  produce
  outcome
  of
  bottlenose
  selection
  and

sample
 biases.
 For
 example,
 the
 study
 by
  reductive
  evolution
  (Maiden,
  2009:1265).

Lee
 and
 Magilton
 (1989:275)
 demonstrates
  The
 gene
 decay
 present
 has
 caused
 leprosy

this
  possibility
  as
  the
  hospital
  cemetery
  to
 be
 an
 almost
 uniquely
 human
 disease,

that
  was
  excavated
  extends
  at
  least
  and
 the
 only
 other
 organism
 to-­‐date
 who

beneath
  the
  modern
  road,
  and
  perhaps
  has
  been
  found
  to
  be
  susceptible
  is
  the

even
  further
  north.
  Further,
  as
  my
  nine-­‐banded
  armadillo
  (Maiden

research
  occurs
  through
  secondary
  2009:1265).
  Regardless
  of
  the
  endemic

sources,
 I
 only
 have
 access
 to
 data
 that
 has
  presence
 of
 this
 disease
 over
 the
 course
 of

been
 excavated
 and
 published
 on,
 and
 the
  human
 history,
 research
 on
 M.
 leprae
 has

data
 is
 presented
 in
 a
 manner
 that
 may
  been
  difficult
  and
  requires
  much

limit
 or
 aid
 in
 my
 research
 efforts.
  persistence.
  The
  bacillus
  reproduces

slowly
  and
  resists
  artificial
  cultivation,

hampering
  our
  understanding
  of
  the

Overview
 of
 Mycobacterium
  disease’s
 aetiology
 (Maiden
 2009).

leprae

Leprosy,
 or
 Hansen’s
 disease,
 is
 caused
 by

Terminology

a
 pathogen
 called
 Mycobacterium
 Leprae,

which
 has
 affected
 human
 populations
 for
  The
  terms
  “leprosy”
  and
  “leper”
  are

at
 least
 4,000
 years
 (Maiden,
 2009).
 This
 is
  controversial
  today,
  as
  the
  opprobrium

confirmed
  through
  archaeological
  associated
 with
 this
 disease
 in
 a
 time
 of

evidence
  from
  an
  ancient
  skeleton
  from
  misunderstanding
  continues
  to
  exist

India,
  which
  dates
  to
  2,000
  BCE,
  which
  today.
  This
  has
  resulted
  in
  the
  disease

shows
  pathology
  consistent
  with
  a
  being
  renamed
  “Hansen’s
  Disease”
  in

diagnosis
 of
 leprosy
 (Robbins
 et
 al.
 2009).
  order
 to
 free
 contemporary
 sufferers
 from

This
  disease
  may
  have
  affected
  such
  negative
  connotations
  (White

populations
 for
 generations
 before
 that,
 as
  2005:318).
  Leprosy
  refers
  to
  the
  chronic

Bogaski
  3
UMASA
 Journal
 Vol
 33(2015)

infection
  caused
  by
  M.
  leprae,
  and
  the
  historical
  interpretation
  of
  disease

term
 “leper”
 refers
 to
 individuals
 who
 were
  causation.

afflicted
 with
 leprosy
 during
 the
 medieval

period.
 My
 choice
 in
 using
 these
 terms
 is

influenced
  by
  my
  desire
  to
  include
  and
  Stigma
 Associated
 with
 Leprosy

understand
 the
 origins
 of
 this
 stigma
 as

It
 has
 long
 been
 believed
 by
 the
 general

well
 as
 my
 desire
 to
 maintain
 a
 tie
 to
 the

population,
 myself
 included,
 that
 leprosy

history
 of
 the
 disease.
 Using
 these
 terms

is
 a
 disease
 that
 carries
 the
 heavy
 baggage

maintains
  these
  metaphorical

of
  social
  stigma,
  fear,
  hatred,
  and

associations,
  and
  in
  re-­‐examining

misunderstanding
  wherever
  it
  is
  found.

historical
 attitudes
 can
 perhaps
 influence

Terms
  such
  as
  the
  “living
  dead”,
  and

contemporary
 responses
 to
 such
 terms.
 In

depictions
 like
 Richard
 Cooper’s
 painting

some
  cases,
  the
  terms
  “leper”
  and

“Medieval
 villagers
 scrambling
 to
 get
 away

“Hansen’s
  disease”
  have
  become

from
 a
 leper”
 (as
 seen
 in
 Rawcliffe
 2006:15)

associated,
 bringing
 the
 prejudices
 of
 the

aid
  the
  propagation
  of
  such
  ideas.

past
 into
 the
 present.
 As
 stated
 by
 White

Alongside
 these
 reports
 there
 are
 various

(2005:318)
  “if
  popular
  meanings
  of

pieces
  of
  literature
  that
  vilify
  lepers,
  or

hanseníase
 reproduce
 those
 of
 lepra,
 the

potentially
 fabricate
 rituals
 of
 separation

name
 shift
 could
 be
 rendered
 irrelevant.”

and
  social
  death
  associated
  with
  the

The
 Latin
 term
 “lepra”
 resulted
 from
 a
  contraction
 of
 such
 a
 disease
 (such
 as
 the

translation
  of
  the
  Hebrew
  “Zara’at,”
  a
  “Leper
 Mass”
 so
 willingly
 quoted
 by
 Covey

word
 for
 skin
 diseases
 found
 in
 the
 Bible,
  [2001:318]
  which
  is
  of
  a
  questionable

and
 originally
 was
 similarly
 used
 for
 skin
  source
  [Rawcliffe
  2006:
  20]).
  This

disorders
  which
  “turned
  the
  skin
  rough,
  propaganda
  on
  the
  social
  prejudice
  and

scaly,
  or
  flaky”
  (Brenner
  2010:390).
  The
  cost
 of
 this
 disease
 has
 likely
 only
 aided
 in

definition
  of
  leprosy
  did
  not
  become
  creating
 more
 fear
 of
 infection
 among
 the

solidified
  until
  later,
  with
  translations
  population.

from
  Greek
  and
  Arabic
  medical
  texts

This
  disease
  was
  not
  feared
  and

dating
  to
  the
  11th
  and
  12th
  centuries
  CE

dreaded
  because
  it
  was
  fatal,
  but
  more

(Brenner
  2010:390).
  Rawcliffe
  makes
  the

likely,
  because
  it
  was
  not.
  Fear
  of
  the

valid
  point
  that,
  even
  with
  the
  medical

effects
 of
 this
 disease,
 which
 is
 amongst

diagnosis,
  in
  medieval
  times
  there
  were

the
 most
 crippling
 and
 potentially
 is
 the

“many
  leprosies:
  of
  bodies
  and
  souls,
  of

most
  physically
  disfiguring
  infectious

saints
 and
 sinners,
 of
 men
 and
 metals,
 of

disease,
  is
  a
  large
  contributor
  to
  the

animals
  and
  plants”
  (2006:43).
  Because

stigma
  associated
  with
  leprosy.
  This

this
 is
 a
 study
 of
 a
 disease’s
 history,
 any

infection
 could
 persist
 for
 the
 remainder

sources
  from
  the
  past
  must
  take
  into

of
  the
  individuals’
  life,
  becoming
  more

account
 the
 variety
 of
 meaning
 ascribed
 to

debilitating
  and
  disfiguring
  as
  the

the
  term.
  Stripping
  the
  term
  from
  the

infection
 progressed,
 with
 no
 known
 cure

disease
  can
  only
  serve
  as
  a
  limit
  to
  our

until
 the
 1940s
 (Sato
 and
 Narita
 2003).
 For

knowledge
  and
  understanding,
  as
  the

some
  with
  a
  stronger
  immune
  response

knowledge
  contemporary
  western

the
 infection
 would
 be
 paucibacillary
 and

biomedicine
 offers
 often
 does
 not
 reflect

could
 be
 limited
 to
 a
 small
 lesion.

Bogaski
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UMASA
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Due
 to
 these
 factors,
 leper-­‐houses
 or
  assault
  (Gilmore
  2008:73).
  The

leprosaria
  were
  believed
  to
  be
  places
  of
  paucibacillary
  form,
  also
  known
  as

isolation
 for
 the
 victims
 of
 leprosy.
 These
  tuberculoid
 leprosy,
 occurs
 when
 there
 is

individuals
 may
 have
 been
 thought
 of
 as
  a
  strong
  immunological
  response,
  and

“unclean”
  or
  “untrustworthy”
  and
  were
  does
 not
 have
 the
 same
 devastating
 and

seen
 as
 evident
 of
 divine
 punishment
 for
  disfiguring
  effects
  on
  the
  body
  as
  the

sin,
 and
 served
 to
 remind
 others
 to
 live
 a
  multibacillary,
 or
 lepromatous,
 form
 may

life
 free
 of
 sin
 (Covey
 2001:320).
 Leprosaria
  have,
  in
  which
  the
  bacillus
  encounters

were
 also
 cited
 in
 the
 19th
 century
 as
 the
  little
  to
  no
  immunological
  reaction

only
 effective
 management
 of
 the
 disease,
  (Gilmore
  2008:73).
  The
  multibacillary

and
  were
  ascribed
  with
  the
  decline
  in
  form,
 if
 left
 untreated,
 can
 lead
 to
 loss
 of

leprosy
 seen
 in
 the
 14th
 century
 in
 Europe
  sensation
  that
  may
  result
  in
  lesions

(Rawcliffe
  2006:13),
  which
  aided
  in
  subject
  to
  secondary
  infection
  (Gilmore

justifying
 isolation
 practices
 at
 the
 end
 of
  2008:73).

the
  19th
  century
  when
  a
  rise
  in
  the

Multibacillary
 Leprosy

prevalence
  of
  leprosy
  occurred.
  Recent

research
 on
 medieval
 leprosaria
 has
 shown
  The
  most
  characteristic
  features
  of

that
  this
  degree
  of
  ostracism
  and
  fear,
  multibacillary
  leprosy
  involve
  the

which
  we
  associate
  with
  poor
  medieval
  rounding
  and
  abnormal
  enlargement
  of

sufferers,
  may
  in
  fact
  be
  a
  much
  more
  nasal
 aperture,
 disappearance
 of
 anterior

recent
  development,
  occurring
  most
  nasal
 spine,
 and
 antemortem
 resorption
 of

acutely
  in
  the
  colonial
  era.
  The
  the
  alveolar
  process
  of
  the
  maxillae

segregation
  policies
  while
  at
  first
  were
  (Suzuki
 et
 al.
 2010:3).

 Degenerative
 and

voluntary,
  later
  became
  enforced,
  and
  reactive
 changes
 on
 the
 palatal
 process
 are

forcible
 separation
 from
 society
 occurred
  also
 descriptive
 of
 the
 disease
 process,
 and

in
  many
  places,
  and
  rewards
  were
  even
  these
  rhino-­‐maxillary
  changes
  are

offered
 to
 those
 who
 brought
 a
 leper
 in
  exclusive
  to
  the
  lepromatous
  or
  near

(Small
 2009:36).

  lepromatous
  forms
  (Mariotti
  et
  al.

2005:213).
 Further
 elements
 that
 can
 aid
 in

the
  diagnosis
  of
  lepromatous
  leprosy

Palaeopathology
 of
 Leprosy
  involve
  periostitic
  changes
  of
  tibia
  and

fibula
 (Suzuki
 et
 al.
 2010),
 and
 “resorptive

There
  are
  several
  characteristic
  lesions

changes
  to
  phalanges,
  metatarso-­‐
that
 occur
 in
 the
 skeleton
 that
 can
 be
 used

phalangeal
 joints,
 diaphyseal
 remodelling,

to
  diagnose
  multibacillary
  leprosy.

cupping
  and
  remodelling
  of
  the
  joints”

Unfortunately
 paucibacillary
 leprosy
 does

(Mariotti
 et
 al.
 2005:313).
 Another
 element

not
 often
 have
 these
 characteristic
 lesions

useful
 in
 diagnosis
 (if
 preserved)
 would
 be

and
  the
  effects
  on
  a
  skeleton
  may
  be

in
 changes
 to
 the
 hyoid,
 as
 leprosy
 often

overlooked
 or
 similar
 to
 other
 pathologies

causes
  lesions
  of
  the
  larynx;
  Gilmore

and
  therefore
  incapable
  of
  producing
  a

(2008:82)
  observed
  skeletal
  changes
  in

positive
 diagnosis.
 When
 contact
 with
 M.

36.6%
 of
 untreated
 multibacillary
 cases
 to

leprae
 occurs,
 there
 is
 a
 significant
 amount

the
 hyoid
 as
 well
 as
 to
 the
 3rd
 through
 6th

of
  variation
  in
  individual
  reactions
  that

cervical
 vertebrae.

depend
 on
 the
 immune
 responses
 to
 the

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  5
UMASA
 Journal
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 33(2015)

  adult
  burial;
  in
  Vedic
  tradition

(originating
  with
  the
  Indus
  civilization),

Archaeological
 Examinations
 and

cremation
  of
  the
  bodies
  of
  individuals

Consideration

with
  leprosy
  was
  not
  practiced,
  as
  their

bodies
  were
  not
  considered
  appropriate

Through
  an
  examination
  of
  knowledge

offerings
 to
 the
 Hindu
 Gods.
 Individuals

garnered
 from
 archaeological
 excavations,

afflicted
  with
  leprosy
  were
  buried,
  and

it
  is
  possible
  to
  illuminate
  some
  of
  the

occasionally
 buried
 alive
 in
 parts
 of
 India

intriguing
  and
  varied
  social
  reactions
  to

(Robbins
  et
  al.
  2009).
  Given
  this

this
  almost
  uniquely
  human
  disease.

information
 with
 no
 further
 research
 into

Beginning
  with
  the
  suspected
  area
  of

the
 cultural
 context,
 it
 would
 be
 simple
 to

origin
  and
  moving
  onwards
  to
  various

identify
 this
 case
 not
 only
 as
 the
 earliest

periods
 and
 regions,
 the
 stigma
 associated

evidence
 of
 lepromatous
 leprosy,
 but
 also

with
  this
  disease
  throughout
  history
  is

as
  the
  earliest
  case
  exemplifying

blurred
  and
  questionable,
  until
  modern

stigmatization
  of
  an
  individual
  with

times.

leprosy
  through
  the
  denial
  of
  normal

India

burial
 practices
 to
 the
 deceased,
 or
 even

The
  earliest
  archaeological
  evidence
  of
  murder
  in
  cases
  where
  an
  individual
  is

multibacillary
  leprosy
  comes
  from
  the
  buried
 alive.

suspected
  area
  in
  which
  M.
  leprae

Looking
  at
  an
  ethnographic
  account

originated,
 India.
 The
 individual
 found
 is
 a

dating
 from
 1869,
 by
 A.
 Campbell,
 we
 can

male
 approximately
 37
 +/-­‐
 5
 years
 of
 age,

perhaps
  understand
  this
  not
  as
  an

and
  dates
  to
  approximately
  2000
  BCE

inhumane
 act,
 but
 one
 of
 compassion.
 The

(Robbins
  et
  al.
  2009).
  The
  skull
  of
  this

individual
 who
 was
 afflicted
 with
 leprosy,

individual
  exhibits
  all
  the
  diagnostic

when
 feeling
 that
 their
 decaying
 state
 was

criteria
  of
  lepromatous
  leprosy.

too
  much
  of
  a
  burden
  on
  relatives
  and

Antemortem
  tooth
  loss,
  remodelling
  of

friends
 “expresses
 a
 desire
 to
 bury
 himself

the
 alveolar
 process
 of
 the
 maxillae
 and
 of

alive”
  (Campbell
  1869:195).
  The
  relatives

the
  nasal
  aperture
  and
  pitting
  in
  the

who
  care
  for
  the
  sufferer
  would
  try
  to

palatine
 process
 are
 all
 easily
 observable

discourage
 this
 thought,
 until
 eventually,

and
 support
 a
 diagnosis
 of
 multibacillary

they
  would
  agree.
  Once
  the
  relatives

leprosy
 (Robbins
 et
 al.
 2009).
 This
 adult

acquiesced
  the
  request,
  a
  funerary
  rite

was
  found
  in
  a
  flexed
  position
  inside
  a

appears
 to
 have
 commenced,
 the
 entirety

stone
 enclosure
 and
 was
 buried
 in
 vitrified

of
 the
 village
 may
 present
 themselves,
 a

ash
 from
 cow
 dung,
 which
 may
 be
 from

pit
 was
 dug,
 which
 the
 leper
 voluntarily

funerary
 rites
 (Robbins
 et
 al.
 2009).

entered,
  then
  the
  individual's
  friends

The
 remains
 were
 found
 in
 northwest
  proceed
 to
 bury
 him
 or
 her,
 and
 finally
 a

India,
  and
  the
  presence
  of
  new
  pottery
  few
 days
 later
 opium
 water
 was
 shared
 at

styles
  and
  monumental
  architecture
  the
  home
  of
  the
  deceased
  (Campbell

suggest
  this
  large
  settlement
  was
  in
  1869).
  Considering
  the
  individuals

contact
  with
  the
  Indus
  civilization
  probable
 knowledge,
 due
 to
 the
 endemic

(Robbins
  et
  al.
  2009).
  This
  connection
  presence
  of
  this
  disease
  in
  India,
  of
  the

could
 explain
 the
 abnormal
 presence
 of
 an
  abysmal
  existence
  of
  a
  leper
  once
  the

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  6
UMASA
 Journal
 Vol
 33(2015)

disease
 progressed
 to
 a
 significant
 extent,
  Late
  Middle
  Ages.
  The
  meaning
  of
  the

requiring
  aid
  with
  quotidian
  activities
  pots
 covering
 the
 heads
 is
 speculative,
 but

such
  as
  feeding,
  bathing,
  and
  dressing,
  it
 has
 been
 hypothesized
 that
 it
 offered
 a

this
  practice
  seems
  analogous
  to
  form
 of
 protection
 for
 the
 living
 from
 the

contemporary
  practice
  of
  euthanasia,
  in
  leprous
 individuals.

which
 a
 suffering
 individual
 may
 ask
 for

Individuals
  from
  Nabe-­‐kaburi
  burials

aid
  in
  ending
  their
  life
  if
  they
  lack
  the

from
  two
  sites
  were
  analysed,
  two
  from

ability
 to
 do
 so
 themselves.
 Although
 this

“Tawara-­‐ga-­‐yatsu”
  and
  one
  from

practice
 is
 not
 without
 controversy,
 it
 can

“Usukobo”,
  both
  sites
  dating
  to
  the
  18th

be
 viewed
 as
 a
 method
 of
 harm
 reduction.

century
  CE
  (Suzuki
  et
  al.
  2014).
  The

Campbell's
  (1869)
  account
  is
  individual
  TK5
  from
  “Tawara-­‐ga-­‐yatsu”

extremely
 ethnocentric
 in
 this
 regard,
 and
  was
  buried
  with
  two
  iron
  pots
  and
  one

does
 not
 take
 into
 account
 the
 societies
  mortar
 pot
 covering
 his
 head
 as
 well
 as

desires
  and
  customs,
  which
  may
  hold
  some
 currency
 and
 three
 glass
 beads,
 and

meaning
  and
  provide
  purpose
  to
  the
  the
 head
 of
 individual
 TK6
 was
 covered

leprosy
  sufferers.
  For
  example,
  Purein
  with
  one
  iron
  pot,
  while
  a
  mortar
  pot

Singh,
  an
  individual
  with
  leprosy,
  was
  covered
  his
  feet,
  he
  had
  five
  pieces
  of

voluntarily
  burnt
  to
  death
  in
  1866
  currency,
  and
  also
  displayed
  skeletal

(Campbell
 1868:196).
 When
 an
 individual
  lesions
 characteristic
 of
 leprosy
 (Suzuki
 et

with
  leprosy
  was
  burnt
  to
  death,
  it
  was
  al.
 2014).
 At
 the
 “Usukobo”
 site,
 individual

believed
 to
 provide
 safety
 to
 their
 entire
  K48
  was
  examined;
  buried
  in
  a
  bent

family
 from
 the
 infection,
 and
 so
 Purein
  position,
  with
  an
  iron
  pot
  on
  the
  head,

Singh
  may
  have
  honourably
  sacrificed
  and
 containing
 a
 smaller
 iron
 pot,
 a
 pipe,

himself
  for
  the
  sake
  of
  his
  kin,
  whereas
  and
  an
  iron
  tablet,
  this
  skeleton
  also

Campbell
 (1869)
 portrays
 the
 family's
 aid
  showed
 skeletal
 changes
 characteristic
 of

in
  his
  death
  as
  a
  terrible
  crime
  that
  leprosy
 (Suzuki
 et
 al.
 2014).
 DNA
 analysis

became
 punishable
 by
 law.
  confirmed
  the
  presence
  of
  M.
  leprae
  in

both
  individuals
  showing
  osteological

Japan:
 “Nabe-­‐kaburi”

evidence
  for
  leprosy,
  and
  returned

Nabe-­‐kaburi
  burials
  from
  the
  15th
  to
  the
  negative
  results
  for
  individual
  TK5,
  who

19th
 centuries
 found
 in
 Japan
 translate
 to
  did
 not
 display
 skeletal
 lesions
 associated

“pot
 –
 put
 on”,
 and
 are
 very
 descriptive
 of
  with
  leprosy
  (Suzuki
  et
  al.
  2014),

what
 these
 burials
 entail;
 an
 individual
 is
  indicating
 these
 burials
 occurred
 not
 only

buried
 with
 a
 pot
 of
 iron
 or
 of
 mortar
 over
  in
 leprosy
 patients,
 but
 also
 in
 a
 broader

their
 heads,
 for
 some
 yet
 to
 be
 determined
  range
 of
 the
 society.

reason
 (Suzuki
 et
 al.
 2014:1).
 There
 are
 105

According
 to
 Suzuki
 et
 al.
 (2014)
 there

burials
 of
 this
 type
 found
 to
 date,
 and
 5

are
 two
 hypotheses
 in
 circulation
 on
 the

out
  of
  21
  skeletons
  examined
  displayed

meaning
 of
 these
 burials.
 One
 hypothesis

pathologies
  consistent
  with
  leprosy

is
 that
 these
 pots
 were
 a
 burial
 method
 to

(Suzuki
 et
 al.
 2014).
 Suzuki
 and
 colleagues

block
  disease.
  The
  second
  hypothesis
  is

(2014)
  noted
  similarities
  between
  the

that
 these
 individuals
 died
 during
 a
 three-­‐
Nabe-­‐kaburi
  burials
  and
  leprosy
  patient

day
 ceremony
 for
 the
 ancestors
 to
 return.

burials,
 and
 believe
 their
 study
 can
 shed

The
  ancestors
  would
  find
  this
  rude
  and

light
  on
  social
  discrimination
  from
  the

Bogaski
  7
UMASA
 Journal
 Vol
 33(2015)

would
  have
  beaten
  their
  heads
  if
  they
  present
  for
  millennia
  in
  Europe
  without

encountered
 them
 on
 the
 passage
 between
  stigma
 evident
 in
 burials
 can
 be
 insightful.

worlds
  and
  so
  the
  pots
  were
  used
  to
  This
 may
 reveal
 that
 it
 may
 not
 have
 been

protect
 the
 deceased
 (Suzuki
 et
 al.
 2014:1).

  due
  to
  the
  increased
  prevalence
  of
  the

disease,
  but
  because
  of
  migrations
  of

Suzuki
 et
 al.
 (2014)
 also
 note
 the
 grave

peoples
 and
 their
 beliefs.

goods
 in
 these
 burials
 are
 similar
 to
 those

found
 in
 common
 cemeteries,
 and
 these
  The
  earliest
  palaeopathology
  with
  a

burials
  are
  often
  found
  with
  ceremonial
  determined
 diagnosis
 of
 leprosy
 in
 Europe

devices
 used
 for
 cleansing
 the
 spirit
 and
  is
 from
 Italy,
 and
 is
 found
 in
 a
 skeleton

offering
 salvation
 in
 the
 case
 of
 an
 unusual
  dating
  to
  the
  4th
  century
  BCE,
  which
  is

death.
  Further,
  these
  individuals
  were
  consistent
 with
 the
 current
 stance
 on
 the

buried
  with
  valuable
  items,
  such
  as
  the
  spread
  of
  the
  disease
  (Mariotti
  et
  al.

iron
  pots,
  provided
  with
  currency
  2005:321).
  The
  skeleton
  displays
  lesions

(possibly
 for
 the
 passage
 to
 heaven),
 and
  and
 bone
 remodelling
 in
 the
 metatarsals,

lived
  long
  enough
  to
  develop
  and
  reduction
  in
  their
  medio-­‐lateral

palaeopathologies
  indicative
  of
  leprosy,
  diameters,
 the
 tibia
 and
 fibula
 show
 signs

suggesting
  palliative
  care
  (Suzuki
  et
  al.
  of
 periostitis,
 and
 the
 hands
 show
 features

2014).
  The
  only
  difference
  in
  the
  burial
  which
 indicate
 hyperflexion,
 all
 of
 which

treatment
  of
  these
  individuals
  from
  the
  are
  usual
  manifestations
  of
  leprosy

burial
 treatment
 of
 others
 is
 the
 “Nabe”
 on
  (Mariotti
 et
 al.
 2005:314-­‐316).
 Some
 other

their
 heads
 (Suzuki
 et
 al.
 2014:7).
 Further
  typical
 manifestations
 of
 leprosy
 are
 not

these
 theories
 are
 not
 mutually
 exclusive,
  present,
  such
  as
  the
  resorption
  of
  the

as
  an
  individual
  afflicted
  with
  leprosy
  anterior
  nasal
  spine
  and
  of
  the
  alveolar

could
 pass
 away
 at
 any
 given
 time.
 If
 the
  process
 of
 the
 maxillae,
 but
 the
 palatine

prevalence
  of
  leprosy
  was
  high
  in
  this
  process
  does
  show
  pitting
  and
  porosity,

population
 a
 number
 of
 individuals
 may
  which
 is
 equally
 if
 not
 more
 important,
 in

display
  skeletal
  markers,
  yet
  could
  have
  the
  diagnosis
  of
  leprosy
  (Mariotti
  et
  al.

lived
  without
  social
  stigma.
  Cross-­‐ 2005).
  Mariotti
  et
  al.
  (2005)
  stated
  the

examination
  of
  all
  Nabe-­‐kaburi
  burials
  intent
 to
 obtain
 DNA
 from
 the
 remains,

with
 non-­‐Nabe-­‐kaburi
 burials
 is
 a
 future
  which
 would
 determine
 without
 doubt
 if

research
  area
  that
  would
  help
  elucidate
  the
  individual
  had
  leprosy,
  and
  which

this
 burial
 method’s
 meaning.
  could
  also
  uncover
  the
  type
  of
  leprosy.

Currently
  no
  further
  articles
  have
  been

Europe

published
 on
 this
 specimen,
 which
 would

There
 is
 speculation
 that
 a
 skeleton
 dating
  help
 to
 elucidate
 the
 spread
 of
 the
 disease.

to
 approximately
 2000
 BCE
 from
 Scotland

This
  burial
  is
  the
  same
  orientation,

had
 leprosy,
 due
 to
 changes
 in
 the
 rhino-­‐
and
 placement
 as
 the
 other
 burials
 of
 the

maxillary
  region
  (Roberts
  2007).
  This

period,
 and
 thus
 at
 such
 a
 point
 in
 time,

would
 stimulate
 a
 change
 in
 the
 believed

perhaps
 at
 the
 point
 of
 introduction
 of
 the

spread
 of
 the
 disease
 to
 Europe,
 currently

disease
  into
  Europe,
  no
  prejudice
  or

held
 to
 be
 approximately
 4th
 century
 BCE

spatial
 segregation
 can
 be
 seen
 (Mariotti

(Mariotti
  et
  al.
  2005).
  Although
  DNA

et
 al.
 2003).
 The
 conclusions
 drawn
 from

analysis
  has
  proved
  inconclusive,
  the

the
 early
 burials
 conducted
 by
 Mariotti
 et

suggestion
  that
  this
  disease
  has
  been

Bogaski
  8
UMASA
 Journal
 Vol
 33(2015)

al.
 (2003)
 is
 mirrored
 in
 the
 findings
 of
 the
  piety,
  such
  that
  if
  an
  individual
  became

research
 conducted
 by
 D.A.
 Lunt
 (2013)
 on
  afflicted
  with
  leprosy
  while
  leading
  a

two
 individuals
 from
 Scotland
 dating
 from
  religious
  life,
  it
  may
  have
  been
  deemed

600-­‐1100CE,
  which
  show
  evidence
  for
  unnecessary
 to
 relocate
 them
 from
 their

leprosy,
 but
 no
 spatial
 segregation.
 These
  brethren
  (Rawcliffe
  2006:254-­‐256).
  The

individuals
 are
 found
 in
 cemeteries
 for
 the
  foundation
 of
 leprosaria
 was
 influenced
 by

general
 public,
 and
 are
 actually
 located
 at
  beliefs
 that
 the
 afflicted
 had
 sinned,
 and

the
  centre
  of
  an
  area
  in
  the
  graveyard
  the
 physical
 illness
 represented
 an
 ailment

showing
 “the
 most
 careful
 arrangement
 of
  of
 the
 soul,
 and
 therefore
 could
 be
 seen
 as

the
  graves”
  (Lunt
  2013:317).
  Lunt
  (2013)
  important
  sites
  of
  conversion
  (Brenner

states
 that
 the
 Scottish
 burials
 are
 similar
  2010).
 Rawcliffe
 (2006:264)
 mentions
 the

to
 the
 majority
 of
 archaeological
 data
 from
  religious
  devotion
  necessary
  to
  maintain

Britain,
  where
  most
  skeletons
  diagnosed
  residence
 at
 such
 institutions,
 and
 states,

with
  leprosy
  are
  buried
  in
  contextually
  “far
 from
 attempting
 to
 detain
 unwilling

normal
  settings.
  While
  literature
  on
  or
 difficult
 residents,
 most
 leprosaria
 had

leprosy
 burials
 in
 “normal”
 cemeteries
 in
  always
  moved
  quickly
  to
  evict
  possible

England
  is
  difficult
  to
  locate,
  there
  are
  troublemakers”.

many
 leprosaria
 cemeteries
 that
 contain
 a

The
 medieval
 hospital
 and
 cemetery
 of

high
  percentage
  of
  apparently
  healthy

St
  Mary
  Magdalene,
  at
  Winchester
  in

individuals
 (Lee
 and
 Magilton
 1989),
 and

England,
  shows
  the
  almost
  exclusive

there
 is
 no
 spatial
 segregation
 of
 leprosy

presence
  of
  lepers.
  Roffey
  and
  Tucker

sufferers
 in
 England
 at
 Blackfriars
 Friary,

(2012)
 argue
 that
 this
 was
 not
 a
 practice
 of

Ipswich
 (Mays
 2009).

exclusion,
  but
  an
  example
  of
  sufferers

Mays
 (2009)
 speculates
 that
 in
 some
  wishing
 to
 pursue
 religious
 vocation
 being

cases,
 due
 to
 familial
 relations,
 the
 custom
  provided
 with
 a
 place
 to
 do
 so,
 which
 also

of
 burying
 leprous
 individuals
 in
 leprosy
  provided
  the
  necessary
  care.
  The

hospital
 cemeteries
 could
 be
 disregarded.
  individual
 most
 afflicted
 with
 the
 disease

This
  is
  based
  on
  a
  rare
  genetic
  scapula
  was
 an
 adult
 male,
 between
 26-­‐35
 years
 of

anomaly
 found
 in
 two
 lay
 burials
 within
  age,
  who
  would
  have
  needed
  daily
  care

Blackfriars
  Friary,
  one
  of
  which
  showed
  with
 feeding,
 dressing
 and
 bathing
 due
 to

leprous
 lesions,
 involving
 changes
 to
 the
  the
  extreme
  progression
  of
  lepromatous

rhino-­‐maxillary,
  region,
  the
  tarsals,
  the
  leprosy
  (Roffey
  and
  Tucker
  2012).
  The

fibula
  and
  the
  tibia
  (Mays
  2009).
  The
  burials
  in
  the
  cemetery
  of
  this
  hospital,

religious
 order
 is
 dependent
 on
 donations
  dating
 as
 early
 as
 1066
 CE,
 are
 carefully

to
 maintain
 function,
 and
 so
 Mays
 (2009)
  laid
  out,
  with
  anthropomorphic
  graves,

believes
 that
 if
 a
 benefactor
 relationship
  similar
  to
  those
  seen
  in
  high-­‐status

would
 be
 sacrificed,
 the
 custom
 could
 be
  ecclesiastical
  sites,
  and
  there
  is
  a
  broad

overlooked.
  According
  to
  the
  data
  distribution
 of
 age
 along
 with
 the
 presence

published
 in
 Mays’
 (2009)
 study,
 another
 4
  of
  both
  sexes
  (Roffey
  and
  Tucker
  2012).

cases
 of
 leprosy
 are
 present
 in
 the
 burials
  There
  is
  also
  the
  burial
  of
  a
  pilgrim

of
 this
 friary.
 It
 seems
 that
 Mays
 (2009)
  present
  in
  this
  cemetery,
  demonstrating

did
 not
 take
 into
 account
 the
 importance
  further
  that
  this
  was
  a
  religious
  site
  of

that
  leprosaria
  placed
  on
  religion
  and
  some
  importance
  (Roffey
  and
  Tucker

Bogaski
  9
UMASA
 Journal
 Vol
 33(2015)

2012).
  individuals
  with
  data
  obtained
  from
  an

isotopic
  analysis
  of
  19
  other
  human

While
 burials
 in
 “normal”
 cemeteries

skeletons
  from
  the
  same
  cemetery,
  but

in
 England
 may
 be
 difficult
 to
 locate,
 there

located
 closer
 to
 the
 church,
 to
 test
 the

was
  a
  study
  conducted
  in
  Odense,

notion
 that
 these
 individuals
 were
 treated

Denmark
  that
  shows
  many
  burials
  of

differently
 in
 life
 as
 well
 as
 death,
 in
 this

individuals
 with
 leprosy
 alongside
 healthy

known
  stratified
  society.
  The
  data

individuals
 (Boldsen
 and
 Mollerup
 2006).

obtained
  indicates
  that
  all
  of
  these

The
  prevalence
  of
  leprous
  lesions
  in

individuals
  had
  the
  same
  diet,
  even

ordinary
  cemeteries
  ranges
  from
  14-­‐17%

though
  the
  leprous
  individuals
  were

before
 1400
 CE,
 after
 which
 rates
 decline

buried
 at
 the
 periphery
 of
 the
 churchyard,

(2006).
  The
  researchers
  suggest
  that

a
  place
  reserved
  for
  the
  low
  status

segregation
  did
  take
  place,
  as
  well
  as

individuals
  (Linderholm
  and
  Kjellström

discrimination,
 based
 on
 the
 separation
 of

2011).

the
  individuals
  with
  the
  most
  advanced

facial
  lesions
  to
  the
  leprosarium
  (2006).
  In
  this
  case,
  the
  burial
  place
  is
  not

This
  is
  based
  on
  the
  foundation
  of
  the
  reflective
  of
  the
  deceased’s
  life,
  as
  we

leprosarium
 between
 1270
 and
 1280
 CE,
 the
  would
 expect
 to
 see
 differences
 in
 the
 diet

high
 prevalence
 of
 leprosy
 present
 in
 its
  if
  these
  individuals
  were
  social
  pariahs,

cemetery
 (95%),
 and
 the
 following
 decline
  although
 quality
 and
 freshness
 of
 the
 food

in
  leprous
  burials
  in
  normal
  cemeteries,
  eaten
  cannot
  be
  assessed.
  There
  is

although
 this
 also
 coincides
 with
 a
 decline
  mention
 of
 burial
 regulations,
 and
 a
 law

in
  the
  prevalence
  of
  leprosy
  in
  the
  assigning
 areas
 farthest
 from
 the
 church

population
  (2006).
  While
  this
  may
  be
  a
  for
  the
  burial
  for
  the
  poor
  and
  outcast

factor
  of
  segregation,
  it
  may
  also
  be
  a
  (Linderholm
 and
 Kjellström
 2011:925).
 This

question
 of
 care,
 and
 the
 quantitative
 data
  is
  the
  cause
  for
  the
  spatial
  segregation,

provided
  by
  these
  burial
  locations
  does
  which
 may
 simply
 be
 due
 to
 reserving
 the

not
 provide
 the
 qualitative
 data
 that
 the
  areas
 closest
 to
 the
 church
 for
 those
 who

study
  by
  Roffey
  and
  Tucker
  (2012)
  are
  more
  likely
  to
  be,
  or
  to
  become,

provides.
  A
  study
  focused
  on
  using
  benefactors.
 This
 law
 has
 no
 bearing
 on

qualitative
 data
 in
 this
 location
 may
 show
  the
 life
 of
 these
 individuals,
 and
 they
 were

that
 those
 with
 facial
 lesions
 were
 those
  cared
 for
 long
 enough
 to
 develop
 skeletal

most
  in
  need
  of
  care,
  and
  therefore
  lesions,
 perhaps
 by
 the
 church,
 perhaps
 by

housing
 within
 the
 leprosarium.
  family,
 or
 perhaps
 by
 the
 community.

In
 Sigtuna,
 Sweden,
 Anna
 Linderholm
  Summary

and
 Anna
 Kjellström
 (2011)
 conducted
 an

These
  cases
  all
  illustrate
  the
  need
  to

isotopic
 analysis
 of
 6
 individual
 skeletons

understand
  more
  than
  the
  spatial

showing
  evidence
  of
  leprosy
  in
  their

arrangement
 of
 a
 cemetery,
 which
 may
 or

remains.
 These
 individuals
 were
 buried
 at

may
  not
  be
  indicative
  of
  the
  life
  of
  the

the
 periphery
 of
 the
 churchyard
 and
 thus

individual.
  Spatial
  segregation
  in
  burial

are
 believed
 to
 of
 a
 lower
 social
 stratum

practices
  can
  express
  social
  segregation,

(Linderholm
  and
  Kjellström
  2011).

but
  practices
  vary
  in
  different
  regions.

Linderholm
 and
 Kjellström
 (2011)
 proceed

There
 is
 no
 clear
 universal
 way
 in
 which

to
 contrast
 the
 data
 obtained
 from
 these

leprosy
  was
  treated,
  and
  no
  clear
  signs

Bogaski
 10