Life and death of a leprosy sufferer from the 8th-century-CE cemetery of Kiskundorozsma-Kettőshatár I (Duna-Tisza Interfluve, Hungary)-Biological and social consequences of having Hansen's disease in a late Avar Age population from Hungary

Abstract

The aim of our paper is to demonstrate a middle-aged male (KK61) from the 8th-century-CE cemetery of Kiskundorozsma-Kettőshatár I (Duna-Tisza Interfluve, Hungary), who appears to represent the lepromatous form of Hansen's disease. Leprosy has affected not only the rhinomaxillary region of his face but also his lower limbs, with severe deformation and disfigurement of the involved anatomical areas (saddle-nose and flat-foot deformity, respectively). Consequently, he would have experienced disability in performing the basic activities of daily living, such as eating, drinking, standing or walking; and thus, he would have required regular and substantial care from others to survive. Despite his very visible disease and associated debility, it seems that KK61 was accepted as a member of the community in death, since he has been buried within the cemetery boundaries, among others from his community. In addition, his grave has conformed to the mortuary practices characteristic of the Kiskundorozsma-Kettőshatár I cemetery (e.g., burial orientation, position of the body in the grave, and type and quantity of accompanying grave goods). Although distinction or segregation in life do not preclude normative treatment in death, the long-lasting survival of KK61 with Hansen's disease implies that he would not have been abandoned but cared for by others. KK61 is one of the few published historic cases with leprosy from the Avar Age of the Hungarian Duna-Tisza Interfluve. His case gives us a unique insight into the biological consequences of living with Hansen's disease and illustrates the social attitude toward leprosy sufferers in early mediaeval Hungary.

Fig 1

A) Map of Hungary showing the location of the Kiskundorozsma–Kettőshatár I archaeological site; B) Aerial photo of the Kiskundorozsma–Kettőshatár I archaeological site; and C) Plan drawing of the late Avar Age cemetery of Kiskundorozsma–Kettőshatár I with the location of the burial of KK61. (Fig 1A contains information from OpenStreetMap and OpenStreetMap Foundation, which is made available under the Open Database License).

Fig 2

A) Photo of the burial of KK61 in situ; and B) Completeness of the skeleton of KK61.

Fig 3

A) Right lateral, B) anterior, and C) left lateral view of the skull of KK61, with severe bony changes indicative of leprosy in the rhinomaxillary region of the face.

Fig 4. Rhinomaxillary lesions in the skull of KK61.

A) Resorption of the anterior nasal spine (white arrow) and the left inferior nasal concha, and widening and rounding of the inferior half of the pyriform aperture (left side); B) Resorption of the anterior nasal spine, the bony nasal septum, the inferior nasal conchae, and the maxillary alveolar process (at the prosthion–white arrow), and widening and rounding of the inferior half of the pyriform aperture; C) Resorption of the maxillary alveolar process (at the prosthion) and pitting, erosion, and perforation (white arrow) on the oral surface of the maxillary palatine process; and D) Resorption of the anterior nasal spine, the bony nasal septum, the right inferior nasal concha, and the maxillary alveolar process (at the prosthion), widening and rounding of the inferior half of the pyriform aperture, and pitting, erosion, and perforation (white arrow) on the nasal surface of the maxillary palatine process.

Fig 5

Alveolar bone recession (white arrows) of the A) maxillary and B) mandibular teeth of KK61, with ante-mortem loss of the mandibular central incisors.

Fig 6. Bony changes indicative of motor peripheral neuropathy in the feet of KK61.

A) Exostoses on the dorsal surface of the left and right cuboid bones (white arrows); B) Bony ridges on the lateral surface of the left calcaneus (white arrow); and C) Exostoses on the medial surface of the right calcaneus (white arrows).

Fig 7. Septic bony changes indicative of sensory peripheral neuropathy in the feet of KK61.

Surface pitting and subperiosteal new bone formations on the A) dorsal and B) plantar surfaces of the proximal end of the left 3^rd, 4^th, and 5^th metatarsals (white arrows), with a small sinus on the 5^th metatarsal; C) Slight ballooning of the diaphysis of the right 2^nd metatarsal (white arrows); Almost complete destruction of the distal end of the right 1^st metatarsal–D) plantar and E) dorsal surfaces; and Remodelling of the proximal end of the right 1^st metatarsal and the right medial cuneiform bone with surface pitting and subperiosteal new bone formations (white arrows)–F) right lateral and G) left lateral view.

Fig 8

Slight surface pitting and longitudinally striated subperiosteal new bone formations (white arrows) on the shaft of the right A) tibia (medial surface) and B) fibula (posterior surface) of KK61. Exostoses (white arrows) on the distal part of the right C) tibia (lateral surface), D) fibula (medial surface), and E) femur (posterior surface) of KK61.