Balathal, India. 2000 B.C.
The site of Balathal is located in northwest India within the contemporary state of Rajasthan. The skeletal remains were excavated from a stone enclosure with radiocarbon dating placing the burial between 2500-2000 B.C. The changes to the skull that indicate leprosy include rhinomaxillary syndrome, destruction of the nasal spine, and expressed infection in the splanchnocranium. (Robbins et al. 2009) The Balathal skull shows evidence of rhinomaxillary syndrome including pitting on the palatine process of the maxilla. The amount of lesions and pitting evident along the nasal spine and palatine process of the skull are characteristic of lepromatous leprosy.
A) Anterior view demonstrates erosive lesions of the nasal aperture, including the anterior nasal spine, and resorption of the alveolar region of the maxilla associated with antemortem tooth loss. B) Inferior view of the maxilla demonstrates changes to the palatine process including pitting near the mid line and in the alveolar region (Robbins et al. 2009).
The postcranial skeleton can also provide evidence for leprosy through direct bacterial invasion, which will leave lesions on limb bones from periostisis or inflammation of connective tissue surrounding bone. Damage to extremities can also be indicative of leprosy because of it's associated nerve damage. The skeletal remains found at Balathal show evidence of injury to the left wrist and infection of the lower limb. However no hand and foot remains were found. The postcranial evidence for leprosy can not be seen as direct evidence but can be useful when combined with other skeletal or cultural evidence (Robbins et al. 2009). This excavation is important because it provides the oldest known example of lepromatous leprosy in the world. However historical accounts and other factors such as the low prevalence and distribution of Type II strains point towards an African origin. Thus the remains found in India provide evidence for the distribution of leprosy in India during the 3rd millennium B.C.
Hatanai, Aomori, Japan
The Hatanai site is located in northeastern Japan and consisted of the excavation of seven cemeteries containing artifacts from a wide range of time periods. The remains that will be examined are identified as SK26 and were excavated from a grave located in an Edo-period (1603-1867) farm village cemetery (Suzuki et al. 2010). By analyzing the grave goods found in the SK26 grave and surrounding sites the burial is estimated to have taken place during the middle 18th to the early 19th century.
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The skull of SK26 shows many of the signs common with leprosy infection. The erosion and pitting of the palatal process and destruction of the nasal aperture and nasal spine are clearly identified. This rhinomaxillary syndrome is further identified by the antemortem loss of all upper incisors and the right canine (Suzuki et al. 2010). These are all indicators of leprosy infection and therefore SK26 was selected for PCR and DNA sequencing.
The samples taken from SK26 were purified using a QIAamp DNA Micro Kit at Tohoku University Museum. After the DNA was extracted and purified the sample was subject to PCR amplification. This process amplifies the M. leprae specific hsp-70 gene and 16S rRNA genes. Two of the samples from SK26, taken from the right maxillary palate and the right fibula, elicited a positve signal for hsp-70 and 16S rRNA genes. In order to confirm the results, DNA sequencing of the positive samples was conducted. This DNA sequence was a 100% match with reported M. leprae sequence for both hsp-70 and 16S rRNA. Further analysis of the DNA identified the genotype of the M. leprae DNA as type-1, which is dominant within India and Southeast Asia (Suzuki et al. 2010).
