Boldsen Jesper L
Institute of Forensic Medicine, Department of Anthropology, ADBOU, University of Southern Denmark.
Anthropol Anz. 2009 Dec;67(4):407-25. doi: 10.1127/0003-5548/2009/0031.
A total of 3033 skeletons from 11 medieval Danish cemeteries and 99 skeletons from the North Scandinavian medieval site of Westerhus were examined for seven lesions indicative of leprosy. The seven lesions are: rounding to the edge of the nasal aperture, degeneration of spina nasalis anterior, degeneration of the alveolar process of the pre-maxilla, porosity or perforation of the palatine process of maxilla, sub-periostal exostoses on the fibula, general swelling of the shaft of the fibula, and degeneration of the 5th metatarsal bone. The dichotomous scores of these lesions were used to estimate sensitivity and specificity of the lesion scores in relation to leprosy and to estimate sample point prevalence of leprosy at death among adults. In turn the estimates of sensitivity and specificity were used to calculate an individual comprehensive statistic, lamda, indicating leprosy status. Among adults the lamda statistic did not associate with age at death, but this cannot be taken as a sign of lack of selective mortality for leprosy but a combination of the opposing effects of long waiting time before developing leprosy related lesions and short survival with these lesions. In urban communities sufferers of leprosy were institutionalized when the leprosarium was established (in Odense around 1275); in rural communities this did not happen but the pattern of burial does indicate an internal segregation of sufferers. In the early Middle Ages (AD 1150-1350) the point prevalence at death among adults of leprosy was higher in rural (25-40 percent) than in urban (10-20 percent) communities, and villages close to town showed lower frequencies of leprosy than villages situated further away from these centers. Leprosy declined in the late Middle Ages, first in towns and cities, later in rural communities. In Odense and Malmö it appears that leprosy was effectively eliminated by 1350 whereas there were still sufferers of leprosy at Øm Kloster around 1550. Leprosy appears to have been less common in North Scandinavia than in South Scandinavia, and there are some indications that leprosy was much more common in the Sámi population than in the North population of North Scandinavia. It is suggested that the rapid and early decline of leprosy in the towns was caused by the breaking of chains of infection by institutionalizing the most affected sufferers from leprosy. In rural communities it is suggested that the later decline of leprosy was brought about by a natural vaccination with the active substance in the Calmette vaccine, Mycobacterium bovis.
对来自11个中世纪丹麦墓地的3033具骨骼以及来自斯堪的纳维亚北部中世纪遗址韦斯特胡斯的99具骨骼进行了检查，以寻找7种表明患有麻风病的病变。这7种病变分别是：鼻孔边缘变圆、鼻前棘退化、上颌前牙槽突退化、上颌腭突多孔或穿孔、腓骨骨膜下骨疣、腓骨干普遍肿胀以及第五跖骨退化。这些病变的二分评分用于估计病变评分相对于麻风病的敏感性和特异性，并估计成年人死亡时麻风病的样本点患病率。进而，敏感性和特异性的估计值被用于计算一个个体综合统计量λ，以表明麻风病状态。在成年人中，λ统计量与死亡年龄无关，但这不能被视为麻风病不存在选择性死亡的迹象，而是麻风病相关病变出现前等待时间长和出现这些病变后存活时间短这两种相反效应的综合结果。在城市社区，麻风病患者在麻风病院建立时（约1275年在欧登塞）被收容入院；在农村社区则没有这种情况，但埋葬模式确实表明患者存在内部隔离。在中世纪早期（公元1150 - 1350年），农村地区成年人死亡时麻风病的点患病率（25% - 40%）高于城市地区（10% - 20%），且靠近城镇的村庄麻风病发病率低于远离这些中心的村庄。麻风病在中世纪晚期有所下降，首先在城镇，随后在农村社区。在欧登塞和马尔默，到1350年麻风病似乎已被有效根除，而在约1550年，奥姆修道院仍有麻风病患者。麻风病在斯堪的纳维亚北部似乎比在斯堪的纳维亚南部少见，并且有一些迹象表明，麻风病在萨米族人口中比在斯堪的纳维亚北部的北方人口中更为常见。有人认为，城镇中麻风病迅速且早期的下降是由于将受影响最严重的麻风病患者收容入院，从而打破了感染链。对于农村社区，有人认为麻风病后来的下降是由卡介苗中的活性物质牛分枝杆菌进行自然接种导致的。
