Leprosy in individuals unearthed near the Ermida de Santo André and Leprosarium of Beja, Portugal

Abstract

Documentary sources refer to leprosy patients in the Portuguese territory since the first century AD, and in the Middle Ages around 70 leprosaria were established. However, prior to 2003 this historical evidence had not been confirmed by archeological findings. The excavation performed in monitoring the rehabilitation done by the Polis program in the area of the Ermida de Santo André (hermitage of Saint Andrew) allowed the exhumation of seven human skeletons, and commingled bones from at least three individuals, in the vicinity of the Beja leprosarium. The objective of this study is to present the paleopathological lesions relevant to the discussion of the differential diagnosis of leprosy. Macroscopic observation of the bones and scrutiny of lesions according to the paleopathological literature allowed the identification of a probable case of leprosy in an adult male, showing rhinomaxillary changes and concentric remodeling of hand and foot bones, and four possible cases (two young adults and two adults, all probably males), with a set of lesions in facial bones and skeletal extremities. The poor preservation of the bones precluded further confirmation of this diagnosis. According to historical data, the leprosaria functioned between the 14th and 16th centuries AD. The exact chronology of these findings was not determined either during the excavation or by radiocarbon dating because the bones presented poor collagen levels. In Portugal as a whole there are few osteological evidences of leprosy, and thus this study adds new information about this chronic infectious disease.